Forum Implantologicum 12 (2016), No. 2 16. Nov. 2016
Forum Implantologicum 12 (2016), No. 2 (16.11.2016)
Prosthetically Driven Techniques to Compensate Peri-Implant Soft Tissue Deficiencies
Belser, Urs / Gallucci, German / Afrashtehfar, Kelvin I. / Buser, Daniel
Local soft tissue deficits often follow tooth loss and implant therapy. Under these circumstances, future implant reconstructions should aim to completely or at least partially compensate this loss in order to minimize any adverse effects, namely compromising subjective patient comfort. In the main, this encompasses disconcerting food impaction, as well as esthetic and phonetic impairment. The present article reviews the relevant prosthetically driven compensation measures, confining itself to the esthetic zone of partially dentate implant patients and fixed dental prostheses (FDP). In this specific context five objectives are of paramount importance: (I) establishing healthy peri-implant soft tissues, (II) avoiding open embrasures, (III) maintaining or recreating a harmoniously scalloped soft tissue course, (IV) achieving the optical illusion of balanced relative tooth dimensions, and (V) providing ease of access for effective plaque control. Six representative clinical examples featuring various degrees of peri-implant soft tissue deficiencies are addressed in detail, highlighting different design guidelines and pointing out their inherent limitations. In the case of minorto- moderate soft tissue deficiencies, achieving the goal by implementing only morphological elements of the so-called white crown substrate such as adequate positioning of facial transition line angles and increased interdental contours is recommended. However, when facing major soft tissue deficiencies, the addition of pink ceramics as an integral part of the implant restoration may become unavoidable to achieve a clinically acceptable result. In this context one has also to take into consideration the position of a given patient's individual smile line as an important decision-making parameter.
Keywords: Peri-implant soft tissue, implant esthetics, soft tissue deficit, implant-prosthetic design, pink ceramics