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Inside Dentistry
June 2021
Volume 17, Issue 6
Peer-Reviewed

Implant Esthetics in an Immediate Restoration Protocol

Incorporating a one-piece ceramic implant design to manage compromised soft-tissue volume and quality

Paul S. Petrungaro, DDS, MS

In the esthetic zone, when replacing a maxillary central incisor for a patient who has a high smile line at the gingival zenith, it is critically important to manage any compromised soft tissue regarding biotype, volume, and thickness. Patients who present with a thin gingival biotype or who otherwise exhibit poor volume and thickness of the facial gingival tissues are at an increased risk of soft-tissue complications from dental implant surgery.

Incorporating metal-free dental implants into protocols for patients with compromised gingival tissues who require tooth replacement, especially in the esthetic zone, can not only improve the esthetics of the restorations but also help to avoid or reduce the occurrence of soft-tissue complications. In addition, two-piece titanium dental implant designs can create subgingival areas at the connection where plaque biofilm can form, potentially resulting in additional concerns for these patients. Therefore, the selection of a one-piece zirconia dental implant design that allows for alteration of the abutment, the collar, and even the implant portion can offer an added level of safety in these compromised implant sites.

A 32-year-old female patient presented for treatment of an endodontically failed left maxillary central incisor. She demonstrated a high lip line when she smiled, a thin gingival biotype, a compromised band of attached soft tissue, and marginal inflammation in the area of the papillary tissues between her maxillary central incisors. Management of this site with a conservative surgical and immediate restoration protocol was essential not only to the success of the implant procedure but also, more importantly from the patient's perspective, to the success of the esthetics. After consulting with the patient and reviewing the pros and cons of a titanium dental implant design when compared with a metal-free dental implant option, the patient opted for a metal-free, one-piece implant design to treat this critical area. Long-term success in cases such as these can also be favorably influenced by the use of a one-piece design because it eliminates the issues associated with the microgap at the junction of the implant/abutment complex in titanium implants and allows for the hemidesmosomal seal that forms between the soft tissues and the implant/abutment complex to remain unaltered.

About the Author

Paul S. Petrungaro, DDS, MS
Diplomate
International Congress of Oral Implantologists
Private Practice
Chicago, Illinois

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