Buser / Belser / Wismeijer Implant Therapy in the Esthetic Zone

Single-Tooth Replacements
1. Auflage 2019
ISBN: 978-1-85097-343-0
Verlag: Quintessenz Verlag
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 268 Seiten

Reihe: ITI Treatment Guide Series

This first volume focuses on implant therapy for single-tooth replacement in the esthetic zone. It guides readers through the entire treatment process, beginning with assessment of the patient's individual esthetic risk profile and proceeding through ideal three-dimensional implant placement and proven prosthetic management options. Various procedures are illustrated through patient case studies. Detailed illustrations serve to clarify any potential ambiguities, and potential complications are explored to avert the most common problems. The ITI Treatment Guide series, a compendium of evidence-based implant therapy techniques employed in daily practice, offers a comprehensive overview of various therapeutic options. Written by expert clinicians of worldwide renown and using an illustrated step-by-step approach, the ITI Treatment Guide shows practitioners how to manage different clinical situations, emphasizing sound diagnostics, evidence-based treatment concepts, and predictable treatment outcomes throughout.

Autoren/Hrsg.

Buser, Daniel

Belser, Urs C.

Wismeijer, Daniel

Leseproben

2   Proceedings of the Third ITI Consensus Conference: Esthetics in Implant Dentistry
The International Team for Implantology (ITI) is a nonprofit academic organization of professionals in implant dentistry and tissue regeneration with over 2000 fellows and members in more than 40 countries. The ITI organizes consensus conferences at 5-year intervals to discuss relevant topics in implant dentistry. The first and second ITI Consensus Conferences in 1993 and 1997 (Proceedings of the ITI Consensus Conference 2000) primarily discussed basic surgical and prosthetic issues in implant dentistry. For the Third ITI Consensus Conference in 2003, the ITI Education Committee decided to focus the discussion on four special topics that had received much attention in recent years, “Esthetics in Implant Dentistry” being one of them (Proceedings of the Third ITI Consensus Conference, published in 2004). A working group was elected for the exploration of each topic. Working Group 2, exploring the topic of “Esthetics in Implant Dentistry,” consisted of the following ITI fellows: Group leader:  Urs C. Belser Participants:    Daniel Buser
                            Jean-Paul Martinet Douteau
                            Javier G. Fabrega
                            Timothy W. Head
                            Joachim S. Hermann
                            Frank L. Higginbottom
                            John D. Jones
                            Hideaki Katsuyama
                            Scott E. Keith
                            William C. Martin
                            Stephen Rimer
                            Johannes Röckl
                            Bruno Schmid
                            Alwin Schönenberger
                            David Shafer
                            Christian ten Bruggenkate
                            Dieter Weingart The group was asked to arrive at a consensus position related to the esthetic dimension of implant dentistry in the anterior maxilla, based on its discussion of and subsequent deliberation on three position papers that had been prepared regarding the following fields: Outcome analysis of implant restorations located in the anterior maxilla Anatomical and surgical considerations of implant therapy in the anterior maxilla Practical prosthodontic procedures related to anterior maxillary fixed implant restorations The subsequent text gives an overview of the consensus statements developed by the group (Belser and coworkers, 2004). 2.1 Consensus Statements and Recommended Clinical Procedures Regarding Esthetics in Implant Dentistry
In esthetic dentistry, difficulties arise in generating evidence-based statements regarding clinical procedures. Therefore, any clinical recommendations given with regard to esthetics in implant dentistry are primarily based on the expert opinion of the Esthetics consensus group. The group worked on each statement until a unanimous opinion was reached. 2.1.1 Statements A: Long-Term Results
Statement A.1 Evidence from the Literature The use of dental implants in the esthetic zone is well documented in the literature. Numerous controlled clinical trials show that the respective overall implant survival and success rates are similar to those reported for other segments of the jaws. However, most of these studies do not include well-defined esthetic parameters. Statement A.2 Single-Tooth Replacement For anterior single-tooth replacement in sites without tissue deficiencies, predictable treatment outcomes, including esthetics, can be achieved because tissue support is provided by adjacent teeth. Statement A.3 Multiple-Tooth Replacement The replacement of multiple adjacent missing teeth in the anterior maxilla with fixed implant restorations is poorly documented. In this context, esthetic restoration is not predictable, particularly regarding the contours of the interimplant soft tissue. Statement A.4 Newer Surgical Approaches Currently, the literature regarding esthetic outcomes is inconclusive for the routine implementation of certain surgical approaches, such as flapless surgery and immediate or delayed implant placement with or without immediate loading in the anterior maxilla. 2.1.2 Statements B: Surgical Considerations
Statement B.1 Planning and Execution Implant therapy in the anterior maxilla is considered an advanced or complex procedure and requires comprehensive preoperative planning and precise surgical execution based on a restoration-driven approach. Statement B.2 Patient Selection Appropriate patient selection is essential in achieving esthetic treatment outcomes. Treatment of high-risk patients identified through site analysis and a general risk assessment (medical status, periodontal susceptibility, smoking, and other risks) should be undertaken with caution, since esthetic results are less consistent. Statement B.3 Implant Selection Implant type and size should be based on site anatomy and the planned restoration. Inappropriate choice of implant body and shoulder dimensions may result in hard and/or soft tissue complications. Statement B.4 Implant Positioning Correct three-dimensional implant placement is essential for an esthetic treatment outcome. Respect of the comfort zones in these dimensions results in an implant shoulder located in an ideal position, allowing for an esthetic implant restoration with stable, long-term peri-implant tissue support. Statement B.5 Soft-Tissue Stability For long-term esthetic soft-tissue stability, sufficient horizontal and vertical bone volume is essential. When deficiencies exist, appropriate hard and/or soft-tissue augmentation procedures are required. Currently, vertical bone deficiencies are a challenge to correct and often lead to esthetic shortcomings. To optimize soft-tissue volume, complete or partial coverage of the healing cap/implant is recommended in the anterior maxilla. In certain situations, a non-submerged approach can be considered. 2.1.3 Statements C: Prosthodontic and Restorative Procedures
Statement C.1 Standards for an Esthetic Fixed Implant Restoration An esthetic implant prosthesis was defined as one that is in harmony with the peri-oral facial structures of the patient. The esthetic peri-implant tissues, including health, height, volume, color, and contours, must be in harmony with the healthy surrounding dentition. The restoration should imitate the natural appearance of the missing dental unit(s) in color, form, texture, size, and optical properties. Statement C.2 Definition of the Esthetic Zone Objectively, the esthetic zone was defined as any dentoalveolar segment that is visible upon full smile. Subjectively, the esthetic zone can be defined as any dentoalveolar area of esthetic importance to the patient. Statement C.3 Measurement of Esthetic Outcomes The following esthetic-related soft tissue parameters are proposed for use in clinical studies: Location of the midfacial mucosal implant margin in relation to the incisal edge or implant...