Implant Treatment in the Esthetic Zone

The maxillary anterior dental implant is perhaps the most challenging for the clinician. Knowledge of esthetics, bone grafting, gingival grafting, and precise implant placement is essential to achieve an implant restoration indistinguishable from the natural dentition, In modern dentistry, mere osseointegration is not enough. We tolerate no less than perfection. Thus, the position that creates the most beautiful and functional prosthesis dictates the location of the implant, not the ridge morphology. Today, we simply grow bone where we desire it.

Techniques that are now available to augment hard and soft tissue at the various phases of treatment will be shown. Techniques will include particulate bone grafting, guided bone regeneration with bio-absorbable and non-resorbable membranes and the use of osteotomes and ridge expanders. Soft tissue procedures to assure optimal esthetic reconstruction before implant placement, at implant placement, at second stage surgery and after second stage surgery will also be demonstrated. These include flap designs to optimize ideal soft tissue profiles, three-dimensional connective tissue grafting, the use of number of second stage surgical flap designs. The requirements and limitation of papilla regeneration between implants, implants and natural teeth, and implants and pontics will be shown.

The sequence and timing of implant placement and regeneration will vary depending on the situation. Implant placement may be immediate or delayed up to nine months depending on the quality and quantity of bone. The advantages and disadvantages of each of the treatment modalities will also be discussed. Four grafting timing possibilities will be discussed:  1) at the time of extraction (site preservation); 2) post extraction (ridge augmentation); 3) simultaneous with extraction and implant placement (Immediate implantation) and 4) post extraction with simultaneous implantation and ridge augmentation (Peri-implant GBR). 

Course Objectives:

• Treatment planning for ideal esthetics
• Gingival augmentation options – grafts and surgical design
• Philosophy of bone regeneration
• When to bone graft and with what
• Treatment sequencing
• Immediate versus delayed placement
• Flap designs 
• Sequencing treatment and provisionalization 
• Socket preservation techniques. 
• Second stage surgical techniques
• Reduction of surgical complications