Sacramento Dental Implant Surgery

Use of the palatal wall as the drilling guide is necessary to not infringe on the facial aspect, to allow room for the management of the emergence profile, and to preserve the papillae. The depth of osteotomy must be sufficient to ensure the best possible quality of anchoring. To get primary stability, the consensus is to have the drilling limit at a minimum distance of 3 to 5 mm beyond the apical limit of the socket. The gap between the implant and the socket wall at the crest should not exceed 1 mm. In this regard, a wider implant is desirable. However, due to interproximal resorption, the selection of an overly wider implant can negatively affect the aesthetics. The distance between an implant and a natural tooth should be kept at a minimum of 1.5 to 2.0 mm so papilla loss can be prevented.

Temporization is a major clinical step in the achievement of a proper aesthetic result in an anterior restoration. Dimension and contour of the crown and stability of the gingival margin are the primary concerns in assuring long-term aesthetics in implant dentistry. Custom guided tissue healing with a provisional restoration is the most predictable way to achieve natural, anatomically shaped tissue and optimal aesthetics.

Surgical Indexing: Some clinicians prefer that an implant registration or index be taken at surgery. The purpose of surgical indexing is to provide a simple means to record the relationship of the newly placed implant to the gingival soft tissue during surgery. This method will allow fabrication of a custom impression coping, which is an accurate and efficient method for transferring a record to the laboratory. This allows the implant team to place immediately after surgery an ideal contoured provisional restoration after surgery. This process guides the soft tissue to heal in a natural morphology that replicates the final tooth form. Because of the discrepancy in the diameter between the implant head and the natural tooth diameter at the cementoenamel junction (CEJ) level, anatomically correct abutments have been manufactured to improve and maximize the aesthetic outcome. These abutments dramatically improve the emergence profile, increase prosthetic stability, and avoid use of ridge-lap design. The soft peri-implant tissues are subject to recession of 0.6 to 1 mm. This can occur during the first three months after surgery.' For this reason, a provisionalization period restoration should remain for at least six months before proceeding with the final restoration. Such delay ensures better emergence pro-file management and papillae preservation.

Ceramic Abutments:

They are usually used in cases in which the labial soft tissue is too thin to allow passage of reflective light from a nonmetallic abutment. Also, due to the anticipated soft-tissue remodeling after implant placement, the use of tooth-colored, ceramic abutment connections has been widely advocated. Aluminum oxide is used as an abutment and restorative material. This material has a high strength, is aesthetic, and maintains an epithelial attachment similar to that of titanium. Another material, the zirconium surface, has also demonstrated reduced bacterial colonization when compared with titanium. The final restoration can be delivered to the patient as an all-ceramic crown (i.e., Procera) cemented over the abutment. Or the abutment itself can be fired with porcelain, serving as the final restoration.

Recent concepts and clinical protocols for an implant-supported anterior single-tooth restoration were described and key factors for aesthetic implant therapy were identified. When specific criteria are care-fully followed to eliminate unnecessary risks, we can achieve a high success rate in terms of an aesthetically optimal result. Proper soft-tissue management and proper prosthetic coordination are the main factors in achieving a natural-looking implant crown. New focus on reduced treatment times, greater procedure knowledge, and improved public awareness will drive increased use of implant therapy in daily practice. In fact, implant placement may not be perceived as surgery by the patient, due to the smooth procedures possible with immediate implant function. So now what? Certainly you can improve your patients' smiles by offering them the tooth-in-a-day concept, knowing that you can provide them with an excellent service, because our patients deserve the best.

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