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IMPLANT POSITION
IN THE ESTHETIC ZONE
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by
Siamak Abai, DDS, MMedSc
Since the advent of modern root
form osseointegrated implant
dentistry in 1952 by Per-Ingvar
Brånemark 1 and colleagues, clinicians
have strived for improvements in
implant positioning in the esthetic
zone to achieve predictable restorative
and esthetic results. Years of clinical
experience in congruence with controlled
clinical studies have led to
established parameters as a guide
for these results. Prosthetic treatment
planning and establishing a set clinical
protocol prior to implant placement
are paramount. It is important to note
that proper implant positioning is
patient- and often implant-specific, and
that inter-patient generalizations can
result in myopic treatment planning
and decrease the predictability of an
esthetic outcome.
Treatment planning prior to implant placement traditionally
begins with comprehensive medical and dental evaluation,
articulated diagnostic casts, periapical and panoramic radiographs,
cone beam computed tomography (CBCT) scans, and
a diagnostic wax-up. Patient demands must always be taken
into consideration prior to surgery, and presurgical mockups
may be necessary to convey the information to the patient.
Prosthetic treatment planning helps the clinician with a
restorative-driven implant placement rather than a bonedriven
approach, with the latter leading to poor abutment
angulations and drastically reduced restorative options. Bone
augmentation is often necessary in order to achieve optimal
residual ridge dimensions prior to implant placement.
The inventive work of Sir Godfrey Hounsfield 2 and the
advancement of CBCT technology have led the dental
profession into a new realm of dimensional accuracy that
is often unattainable with conventional dental radiography.
In combination with the use of a surgical or guided stent,
proper 3-D positioning of a dental implant has become
an attainable goal, leading to increased confidence for
the clinician and accurate clinical results. The importance
– Implant Position in the Esthetic Zone – 27