Sacramento Dental Implant Treatment Options

The fastest growing treatment option is the anterior single-tooth replacement. In fact 70% of singletooth replacements are central incisors. Today replacing a missing single tooth with an implant supported crown has a predictable success rate of 95% and greater. In addition maintaining healthy tooth structure is a primarily goal in successful restoration of pulpless teeth, and the amount of remaining solid tooth structure is an important guideline for retaining or extracting. Once a tooth is compromised due to decay, resorption, or fracture, we can manage the hopeless tooth with an implant. Often an immediate implant is a favorable option.

A 24-year-old patient with a severely decayed tooth #9 and healthy adjacent teeth presents to your office. What are the options? What is the best long-term prognosis for repair or replacement for this patient? Restoring tooth #9 with a crown lengthening, a cast post, and a crown is an option, but would an implant crown be a more conservative and successful solution for this young patient?

Biological Findings Guiding Aesthetic Implant Restoration Biological Width Principle: Gargiulo' has shown the width of the dentogingival complex surrounding natural teeth to be approximately 3 mm. A study by Cochran3 demonstrated a similar dimension in the peri-implant tissues. Based on this principle, the desired depth of placement of an implant below the free gingival margin of soft tissue should be 3 mm to 4 mm.This distance provides space for biologic width, proper emergence profile, and aesthetics. This distance should allow bone remodeling that occurs during a one-year period.'

The Papilla:

The presence of interdental papilla is directly related to the distance between the contact point and the interdental crest of bone. The critical distance between teeth was reported to be 5 mm or less.' As the distance exceeds 5 mm, the presence of the papilla drops significantly. It has also been shown that when an implant is placed adjacent to a tooth, the distance from the crestal bone on the tooth to the contact point should be 5 mm or less in order to reform predictably a papilla. A period of six-month provisionalization is necessary to manage the emergence profile and the preservation of the papillae.'

The Biologic Width in implant Adjacent to a Health Tooth:

The bone level interproximally is maintained at its original level because the biologic width at the tooth side remains undisturbed. This is particularly true if the implant is not placed in close proximity to the root surface. A minimum distance of 1.5 mm between the implant and the adjacent tooth allows for preservation of the interproximal bone peak.

Tissue Biottipe and Thickness:

The type of periodontium (thin scalloped or thick flat) determines the degree of scalloping of the bone.The difference between the facial bone crest and the interproximal bone crest can range from 2.1 mm to 4.1 mm.7

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