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SINGLE-TOOTH
REPLACEMENT AND
IMPLANT ESTHETICS
PRESENTED BY:
Dr DIPIKA GARG
MDS 1ST YEAR
DEPT. OF PRSOTHODONTICS
CONTENTS
-ALTERNATE TREATMENT OPTIONS FOR ANTERIOR SINGLE-TOOTH
-REPLACEMENT
-SINGLE-TOOTH IMPLANT
-FACTORS INFLUENCING TREATMENT
-SPECIFIC SINGLE-TOOTH IMPLANT INDICATIONS
-THE PERIIMPLANT FRAME AND SOFT AND HARD TISSUE
CONSIDERATIONS
-IMPLANT POSITION : DEPTH
-IMMEDIATE IMPLANT INSERTION AFTER EXTRACTION
-SOFT TISSUE EMERGENCE CONTOUR
-PROSTHETIC PHASE
-COMPLICATIONS
Causes of max. anterior single tooth loss
• Agenesis
• Trauma
• Endodontic failure
• Fracture
• Resorption
• Caries
Replacement options
• Traditional FPD
• Cantilever FPD
• RPD
• Acid- etched resin bonded FPD
• Implant supported crown
Traditional FPD: complications and
reasons for failure
• Caries
• Endodontic therapy
• Uncementation
• Fracture
-porcelain
-tooth
• Esthetics
Contraindications to anterior FPD
• Anodontia
• Root resorption
The Peri-implant Frame And Soft And
Hard Tissue Considerations
black triangle
• The distance from the facial free gingival margin
to the height of the interproximal papilla is
usually 4 to 5 mm, and therefore the inter dental
papilla height is about 50% of the exposed tooth
length.
• The biotype of the gingiva usually is called thick or thin.
• Thicker tissue is more resistant to the shrinkage or
recession and more often leads to the formation of a
periodontal pocket after bone loss.
• Thin gingival tissues around the teeth are more prone to
shrinkage after tooth extraction and more difficult to
elevate or augment after tooth loss.
• Gingival recession is the most comrnon esthetic
complication after anterior single-tooth extraction and is
also a concern after implant surgery and uncovery.
Surgical Considerations
SITE SUTURED.
• The bone regenerated over the facial aspect of the
implant with guided bone regeneration (GBR) is often
immature woven bone, which is more prone to occlusal
overload.
• The inability to achieve proper esthetic and health
parameters constitutes a compromised result and
increased risk of esthetic or implant failure.
• When the implant is countersunk below the facial bone,
the implant platform may be up to 4 mm apical to the
CEJ of the adjacent teeth, which increases the
anatomical crown height.
• In addition, synthetic grafts placed around the titanium
implant grow less dense bone, which also is limited in
implant contact.
• The risk of postoperative infection
around the implant also is increased
with an immediate insertion because
of the bacteria associated with the
cause of tooth loss when judicious
case selection has not been
exercised.
• The presence of exudate lowers the
pH, which causes a solution-
mediated resorption of the grafted
bone and contaminates the implant
body with a bacterial smear layer,
which in turn reduces bone contact .
• The benefits of immediate implant insertion after tooth
extraction are related to an improved preservation of the
soft tissue drape and the bone architecture, compared
their collapse after tooth extraction.
• As a result, bone augmentation and soft tissue grafts can
be avoided.
• Therefore under ideal conditions that include lack of
pathologic conditions, thick gingival tissues, ideal bone
contours, ideal soft tissue contours, and square tooth
forms, the dentist may consider an immediate implant
insertion after tooth extraction.
SOFT TISSUE EMERGENCE CONTOUR
DISADVANTAGE DISADVANTAGE
• Expansion of cingulum • if margins of abutment
are subgingival, excess
cement may lodge.
• Retrievability is
extremely difficult
3. Abutment selection.
Advantages
• Simple to use
• Minimal chairside and laboratory time
• Predictable fit with implant-prosthesis components and anti-rotation feature
already present.
• Good retention
• Wide range of collar sizes
Disadvantages
• Design may increase bulk, limiting aesthetic
outcome
• Donot follow gingival contour
• Cannot be customized.
PREPABLE ABUTMENTS
Material of manufacture
• Titanium
• Gold alloy
• Ceramic
Advantages
• Suitable for all cases
• Allows for angulation changes
• Modification allows for good gingival contour
Disadvantages
• Increases clinical and laboratory time
CUSTOMIZED ABUTMENTS
Material of manufacture
• Gold alloy
• Titanium
• Zirconium
• Ceramic
Advantages
• Suitable for all cases
• Allow for angulation changes
• Modification allows for good gingival contour
Disadvantages
• Increases clinical and laboratory time
• Material choice influenced by occlusal loads
Assessment of abutment choice