International Journal of Esthetic Dentistry (EN), 01/2007

The esthetic success of anterior implant therapy still depends primarily on the degree to which natural soft tissue harmony can be preserved or reestablished. Many techniques have been described to preserve or augment the contour and volume of soft and hard tissues, particularly in the anterior maxillary zone. The level of predictability, however, remains variable. This article describes some clinical observations that may increase predictability in selected cases.

In a 40-year-old woman, a central incisor was to be replaced with an implant-supported crown. When the implant was uncovered, the soft tissue around the implant showed an unfavorable profile: The adjacent lateral incisor showed significant loss of periodontal attachment. Subsequent soft tissue and connective tissue grafts failed to correct the problem, and an alternative treatment plan was formulated. Errors in the initial treatment, including incorrect implant position and failure to analyze the cause of the periodontal attachment loss are discussed in detail; the options for further treatment measures are outlined; and the treatment that was subsequently carried out is presented.

The restoration of the missing maxillary incisors is a complex and delicate treatment challenge. When implant therapy is used, proper treatment planning is critical, as selecting the proper number, location, and dimension of the implants is a difficult task. Thus, this article discusses the issues that must be addressed during diagnosis and treatment planning to achieve a predictable esthetic outcome when using implants to replace the maxillary incisors. The advantages and disadvantages of several implant-supported treatment options-using a combination of regular- and narrow-neck implants-are presented. Ultimately, the use of narrow-neck implants at the lateral incisor sites is presented as the best option for ensuring excellent esthetic outcomes, and the corresponding indications and contraindications are discussed. Further, all treatment options are ranked based on the predictability of their esthetic outcomes.

A collaborative relationship between prosthodontists and dental technicians can greatly improve the esthetic and functional results of restorations. When each discipline takes the time to understand the strengths and challenges of the other, together they can formulate a treatment plan that will culminate in a successful result. The diagnostic waxup gives the dental team a threedimensional illustration of the problem and allows the patient to view the problem and discuss solutions. Intraoral records taken by the prosthodontist are used with the technician's centric relation jigs to properly mount the casts. When the prosthodontist and technician agree on materials to be used in the fabrication of the provisional prosthesis and master dies, more accurate and functional results are achieved. Of special interest are the tooth preparations: The shape of the margins can enable the dental technician to easily create an accurate restoration. A treatment waxup allows full communication of information about the restoration between the prosthodontist, dental technician, and patient, ensuring that all three parties are satisfied with the look and function before the definitive restoration is made. The type of material and the color properties for the definitive restoration are of utmost importance, and the combined skills and experience of the prosthodontist and dental technician can create an excellent result. This article defines specific points in the restorative process when a collaborative effort between the prosthodontist and the dental technician dramatically improve the end result.

In implant dentistry today, precise preoperative planning of both the implant placement and the restoration is a critical prerequisite to succeeding in the oral rehabilitation of patients with dental implants. Modern three-dimensional imaging techniques such as digital volume tomography allow the acquisition of radiologic data with very low levels of radiation and excellent image accuracy, and also allow the processing of these data with various types of software applications. Formerly, only the position of the implant collar or the axis of the osteotomy could be transferred into the clinical setting; it is now possible to predetermine the precise three-dimensional position of the planned implant before the actual implant insertion, and to transfer this position to the surgical site. Thus, the restoration can be fabricated before surgery and can be placed into the patient's mouth immediately after surgery. Treatment planned in this way is fast, minimally invasive, and most importantly, predictable. This increases the quality of both the surgical procedure and the restoration. For three-dimensional navigation in implant dentistry there are static systems based on both surgical guides and optical, dynamic navigation systems. This article is an overview of the latest systems for guided implant insertion and their fields of application.

Over the last 15 years implant dentistry has made great progress. Especially in the anterior region, esthetics plays a vital role in treatment. Patients expect not only a fully functional restoration, but also an esthetically pleasing and long-lasting solution. A predictable and esthetic result can only be achieved by adhering to a proven clinical protocol, which is based on experience, precise diagnostic procedures, and meticulous treatment planning. This article presents a practical protocol used in the authors' practice for esthetic reconstructions with dental implants in the anterior region with four patient cases.

Throughout his career, Professor Peter Schärer developed and helped establish some of the most significant advancements in dental technology and technique. In honor of his legacy, this article presents a number of Prof Schärer's most notable contributions to the field, such as the hotpressing technique, full waxup try-in, and advancements in zirconium oxide materials. Professor Schärer's dedication to bold and innovative ideas, as well as his philosophy of collaboration between the dentist and dental technician, are responsible for vast improvements in the field of dental technology, many of which are now recognized worldwide.