Achieving an ideal esthetic outcome with implant-supported rehabilitation of missing teeth is a challenging procedure, especially in the anterior zone. Numerous clinical variables have been reported to impact the ultimate treatment outcome. Thus, a comprehensive understanding of the anatomic, biologic, surgical, prosthetic and patient-centered factors must be pursued to obtain an optimal and predictable result. This article summarizes most of the variables contributing to esthetic and biological success in implant prosthodontics of the anterior zone and to provide key treatment considerations on the decision-making process of replacing missing anterior teeth with dental implants.
Abstract
Introduction
Achieving esthetic success with implant replacement of missing teeth is often a challenge. Predictable results can be achieved when adequate diagnosis is performed, together with selection of scientifically supported treatment principles. Several clinical variables have a substantial impact on the treatment outcome of fixed implant-supported rehabilitation in the anterior maxilla zone. Thus, implant treatment planning in the esthetic zone should entail a comprehensive understanding of anatomic, biologic, surgical, prosthetic and maintenance principles (Belser, Buser & Higginbottom 2004; Buser, Martin & Belser 2004; Gallucci, Guex et al. 2007; Higginbottom et al. 2004; Martin et al. 2014; Ntounis et al. 2015).
The use of dental implants in the esthetic zone should ideally aim at achieving a natural looking implant-prosthodontic complex integration in harmony with the adjacent dentition (white esthetics) and gingival tissues (pink esthetics) (Furhauser et al. 2005; Belser et al. 2009).
In this context, the ITI SAC Classification in Implant Dentistry aims to provide clinicians with a systematic assessment for dental implant therapy in the esthetic zone (SAC classification, risk assessment 2009 - Adapted from the ITI’s SAC Classification in Implant Dentistry 2nd Edition, 2021).
Patient perspectives should be regarded with caution (Stefanini et al. 2018). Esthetic risk variables should be communicated and addressed with the patient before treatment to avoid any post-treatment misunderstandings that may occur in the case of a final compromised outcome that would not meet the patient’s expectations. For these reasons, the ITI’s Esthetic Risk Assessment (ERA) suggests pretreatment evaluation of the parameters affecting both surgical and prosthetic procedures in the esthetic area. This is an exceptional communication and educational tool for both clinician and patients (Buser, Martin & Belser 2004; Belser, Buser & Higginbottom 2004; Higginbottom et al. 2004). Several other treatment strategies addressing optimal implant placement and restoration in the esthetic zone have also been presented (Martin et al. 2014; Morton et al. 2014; Morton et al. 2018).
The objective of this article is to evaluate the variables that influence success in implant prosthodontics in the esthetic zone and to provide key treatment considerations for the decision-making process when replacing missing anterior teeth with dental implants.