Esthetic and functional considerations for implant restoration of the partially edentulous patient

Abstract

Suggestions for esthetic enhancement are provided and functional and occlusal considerations discussed for the partially edentulous implant candidate. Among the techniques the surgical/restorative team might consider are sinus lifts, bone contour augmentation for enlarging alveolar width, nerve repositioning, guided tissue regeneration, and soft tissue augmentation with split-thickness palatal grafts for gingival harmony. Mounted diagnostic casts and wax-ups should be prepared. Specific suggestions for esthetic enhancement include orthodontic correction of drifted or hypererupted teeth, possible segmental or full arch orthognathic surgery, soft tissue augmentation, and the assessment of gingival consistency and thickness around the adjacent teeth. Suggestions to address the functional demands of fixed restorations include presurgical procedures to permit maximum implant lengths and optimal angulation, the use of a nonlinear tooth arrangement, long-term maintenance of the occlusion, and positioning implants in the original tooth positions to create natural cervical emergence profiles. For single-tooth restorations, implants should be placed at least 3 mm apical to the cementoenamel junctions of the adjacent teeth. Satisfactory surgical handling of the interproximal papillae is necessary to maintain appropriate contours. Modifications of gingival architecture should be made during the prosthetic phase of treatment.