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type of connection between implant, and prosthetic components.
11 Several factors are cause for concern in the
apico-coronal placement of implants. Implants placed too
shallow may reveal the metal collar of the implant through
the gingiva. Countersinking implants below the level of
the crestal bone may give prosthetic advantages with more
running room for prosthetic components and tissue contouring,
but can lead to crestal bone loss due to the location
of a microgap at the implant-abutment interface. The
ideal solution to exposure of the implant collar would be
the placement of an implant equicrestal or subcrestal to
the ridge. However, the existing microgap at the implantabutment
junction leads to bone resorption due to periimplant
inflammation. 12 It is suggested that an implant collar
be located 2 mm apical to the CEJ of an adjacent tooth
if no gingival recession is present 13 (Fig. 3). Implant diameter
also plays a role in apico-coronal position, with smaller
diameter implants needing more space for soft-tissue development
and tissue contouring.
Figure 4: Proper implant angulation with screw access in the cingulum area
Figure 3: Lateral view of implant placed with the collar at the level of crestal bone
with adjacent teeth CEJ 2 mm coronal to the collar of the implant
IMPLANT ANGULATION
Implant angulation is particularly important in treatment
planning for screw-retained restorations. Implants angled
too far labially compromise the placement of the restorative
screw, leaving the clinician with fewer restorative options.
Implants angled too far lingually can result in unhygienic
and unesthetic prosthetic design. For every millimeter
of lingual inclination, the implant should be placed an
additional millimeter apically in order to create an optimal
emergence profile. 14 In general, implant angulation should
mimic angulation of adjacent teeth so long as they are
in reasonable alignment (Fig. 4). Furthermore, maxillary
anterior regions require a subtle palatal angulation to
INCLUSIVE TOOTH
REPLACEMENT SOLUTION
The Inclusive ® Tooth Replacement Solution was developed
by Glidewell Laboratories as a complete, prosthetically
driven method of restoring missing dentition. The solution
comprises treatment planning, implant placement, patientspecific
temporization, and the definitive restoration
(Figs. 5a–5f). When utilizing the comprehensive range of
Inclusive Digital Treatment Planning services for guided
implant surgeries and restorations, the clinician has absolute
and precise control of each step. This results in an efficient
and accurate workflow that is beneficial for the clinician and,
ultimately, the patient. With the Inclusive Tooth Replacement
Solution, the clinician has control of the four dimensions of
implant placement in the esthetic zone, creating a consistently
predictable result. Having a single source of services and
materials is also advantageous in providing a more affordable
yet high-value product for patients.
increase labial soft tissue bulk. 15 – Implant Position in the Esthetic Zone – 29