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