International Journal of Esthetic Dentistry (EN), 04/2007

Restoring failing anterior teeth with a dental implant restoration when there is significant damage to the bone, soft tissues, or both presents a difficult clinical challenge. The goal is to produce a result in which the soft tissue contours, papillae, and in particular the labial soft tissues remain stable over time. While a number of techniques have been utilized, socket preservation and socket seal in combination with immediate or delayed implant placement can be a valuable protocol. The use of this technique is illustrated in two challenging cases of patients with high lip lines.

To meet the ever-increasing demands of well-informed patients, an interdisciplinary team approach is imperative to achieve optimal esthetics and function in complex rehabilitations. Orthodontic pretreatment is one viable option to improve a clinical situation prior to restorative treatment. An individual diagnostic waxup can be used to educate patients about treatment options, lower unrealistic expectations, and serve the technician as a blueprint for ideal framework design. Newly developed dental materials and computer technology have led to new restorative treatment options for both conventional and implantretained restorations. With the increased processing power of computers over the past decade, computer-aided design/ computer-assisted manufacture (CAD/ CAM) copings, frameworks, and abutments for conventional and implant-supported restorations have significantly altered treatment protocols for dentists and dental technicians. CAD/CAM-generated oxide ceramic components can be used to achieve optimal esthetics in any area of the mouth.

Recognizing the treatment factors that will increase the predictability of regenerative surgical procedures may encourage periodontal treatment of apparently hopeless teeth. This case report describes the longterm clinical outcome of a periodontal (15 mm of clinical attachment loss) and bone defect associated with a periapical lesion affecting a maxillary lateral incisor in an esthetically demanding, systemically healthy young patient. Treatment procedures comprised endodontic treatment of the periapical lesion and cause-related therapy aimed to eliminate bleeding on probing and control the infection in the rest of the mouth. Four months later, a regenerative surgical technique combining the simplified papilla preservation approach, application of enamel matrix proteins and bovine porous bone mineral, and a coronally advanced buccal flap at the adjacent teeth in the surgical area was performed. Clinical examination at the 1-year recall revealed clinical attachment gain (8 mm) with shallow residual probing pocket depths (3 mm) and a slight (1 mm) increase in gingival recession. The esthetic appearance of the treated tooth was improved via the addition of odontoplastic and resin composite. Three years postsurgery, both the esthetics and the periodontal health were fully maintained. The present case report suggests that successful periodontal and esthetic results can be accomplished and maintained for at least 3 years after regenerative treatment of an apparently hopeless tooth with extremely severe baseline periodontal conditions.

The aim of this paper is to present a system for taking standardized photographs at different phases of treatment and making objective measurements based on these photographs, thus providing an objective comparison of various stages of therapy. This system situates a digital camera in a fixed relationship to stone casts of preselected clinical situations. After the photographs are imported to computer software, lines and points can be traced and then independently transferred from one picture to another. The technique makes it possible to compare the outcome of a certain procedure with a linear error 0.1 mm. The system can be used to analyze, compare, and measure vertical changes of the soft tissue margins, thus allowing for an objective, reproducible evaluation. The ability to measure results is important not only for clinicians who are committed to increasing their knowledge and improving their clinical procedures, but also for researchers who aim to compare a situation before, during, and after treatment to determine the efficacy of different techniques.

Full-arch implant-supported fixed dental prostheses are a well-documented therapeutic approach for completely edentulous patients that restores the biologic and functional aspects. In many cases, the esthetic needs of patients can be successfully addressed as well. This is achieved by restoring both the dental and facial esthetic components. However, in some instances full-arch implant-supported fixed dental prostheses may negatively influence the upper lip support and lower facial features of the patient. In this preliminary observation, 412 patients were examined to determine if certain factors were related to a specific minor alteration of the morphologic facial characteristics. The results show that soft tissue defects in the upper lip philtrum area may develop in patients treated with full-arch implantretained fixed dental prostheses and who share certain etiologic factors.