Esthetic Rehabilitation with Immediate Implant Loading
Immediate implant placement in extraction wounds has been performed for more than 20 years. According to a number of authors the success rate is comparable to that of delayed implant placement. The reduced treatment time has huge benefits both for the dentist and for the patient, and the predictability of this method is comparable to the protocols for delayed and early implantation.
On the other hand, immediate implant loading also has many advantages for the patient like immediate function, good aesthetics and improved self-esteem. Many studies support the excellent outcomes that immediate loading can provide. Massimo Del Fabbro et al. conducted a study on 2000 implants, placed and immediately loaded in the aesthetic zone. They reported a success rate of around 97.60% after a period of 10 years.
Nowadays the implant treatment in the aesthetic zone is made accordingly the anatomical and aesthetic rules. The golden standard is to place the implant 2-3mm from the CEJ of the adjacent teeth. There is number of criteria for the deciding the design of the future restoration and smile and to determinate the vertical position of the implant. Guided surgery is increasing its popularity, giving the clinician very good VL, MD positioning and giving the right torque.
It is extremely important for every single patient the teeth proportions to be correctly diagnosed before an irreversible restorative dental procedure to be done. By creating a smile design we are building a conception of perception by which we are trying to satisfy the patients’ wish for an aesthetic vision.
Our knowledge and experience so far indicate that there are several key factors for the predictability of the immediate implantation used in combination with immediate loading in the aesthetic zone:
1. The esthetic analysis done prior to the treatment is of utmost importance for creating a project of the desired outcome.
2. The implant should be placed in the exact position according to the project and should have a slightly palatal orientation so as to ensure the stability of the vestibular bone.
3. A conservative insertion protocol should be applied which involves drilling of the bone at a low speed.
4. The use of multiunit abutments has various advantages: first of all, they allow for the conversion of bone level implants into tissue level implants. Secondly, they concentrate the stress into the tissues at the gingival level, away from the implants body. Last but not least, with these abutments a screw retained crown with the right emergence profile can be easily fabricated.
5.The occlusion should be taken into consideration articulators should be always used and the constructions should always be tried in function, without full contacts or articulation blocks on them for the first 2 months.
6. A second provisional construction should be used in order to adjust the tissues and to allow for an esthetic preview.
7. An abutment with friction fit connection should be used for the final prosthetic construction.
The conception of VisagiSmile helps dentists to do restorations that corresponds not only to the esthetic but also to the psychological features of the created image which affects the emotions, identity, behavior and confidence of the patient. On the other side these factors affect the way the observed persons react to the definite treatment of the patient.
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