From Volume 46, Issue 11, December 2019 | Pages 1003-1014
A prosthetically-driven approach for dental implant placement offers the most predictable means of achieving a biologically stable and aesthetic implant-supported restoration. Optimal dental implant placement may be limited by local factors and complicate the prosthetic reconstruction. This article aims to offer guidance on the surgical and prosthetic options available to manage suboptimally-positioned dental implants.
The popularity of implant-supported restorations has led to the development of increasingly innovative clinical techniques to provide successful and aesthetic tooth replacements. Successful implant outcomes are underpinned by positioning the fixture at the optimal vertical and horizontal position within the alveolar bone, encouraging the development of a healthy peri-implant soft tissue collar1 and reducing the risks of peri-mucosal complications.2 The importance of this implant-tissue association has led to the development of ‘prosthetically driven’ surgical protocols, where the optimal prosthetic tooth position2 is used to determine the correct spatial position for the implant fixture.
Failure to achieve the ideal horizontal and vertical spatial relationships can lead to problems. Horizontal misalignment within the buccal plane may increase the risk of alveolar bone loss3,4 and mucosal recession2,5,6 (Figure 1). In contrast, palatal placement risks an inferior emergence profile of the prosthetic crown.7 Inappropriate mesial-distal implant position may also affect the shape and size of the interproximal papilla,8 with failure to achieve a 1.5–2 mm peripheral bone margin, resulting in loss of the papilla height, reduced thickness of the gingival collar and an undesirable embrasure form and emergence profile.
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