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Dawson Quick Tips: Esthetic Restorations with Dental Implants

Welcome to Quick Tips. Today I want to give you some guidance when you are planning an esthetic restoration in the front of the mouth that's going to involve an implant.

What to look at first

Correct Incisal Edge PositionWhen we look at these type of cases, the first thing we've got to be considering is the precision of that maxillary incisal edge. The second thing we have to think about is once we get that maxillary incisal edge figured out, where that gingival plane is going to be because that is going to be determining the optimum length of the tooth.

Correct Gingival PositionAnd then from there we have to think about how far that free gingival margin has to be from the head of the implant. Remember the incisal edge to free gingival margin really determines the length of the tooth.

Now we can plan the precise placement of the implant. We have our incisal edge position and we have our free gingival margin. We also know from the biology of implants that if the head of that implant can be about 3 millimeters from our free gingival margin, that gives us the room to be able to shape the tissue, support those papillas and have a great result.

So at the Dawson Academy, if you have an implant we still do everything the same way.

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We're still going to do our full series of photographs, we're going to do our TMJ occlusal exam, we're going to get really good, accurate models so we can study the occlusion, and then we can add to the mix a cone beam radiograph to get crystal clear on where this implant is going to need to be placed.

Digital technology's place

Sirona Digital ScannerWe also have digital technology today that allows us to scan the patient's mouth. In this case we are actually scanning the preps on the adjacent teeth. We can virtually place the implant, and on this type of data - this happens to be the one from Sirona - making a guide that will go precisely in the patient's mouth and be able to very, very specifically put the implant not only in the right buccal lingual direction, but also to the specific depth.

So again visualizing incisal edge, visualizing where we want the free gingival margin to be, and making sure we get that implant deep enough so that we've got that three millimeter dimension. That becomes very important for what we do, to now four or five months later be able to make a restoration, that is going to be, in this case, screwed in place.

Notice the position of that tooth in relationship to the preps on either side so that now when we complete our try-in appointment here, we can start to see that we've got restorations that are going to look life-like, and have all that tissue fill in.

Summary

When we're planning these type of restorations remember this criteria. We must still go through the same visualization that we normally do, but we've got to add some components. And the main components is that cone beam x-ray, so that we can go from a incisal edge to free gingival margin, to the specific depth of the implant to be able to get restorations that look like this.

So I hope this has been helpful, and I look forward to seeing you next time on Quick Tips.

Dental Implants for the General Dentist

John C. Cranham, DDS has an esthetic oriented practice in Chesapeake, Virginia. An honors graduate of the Medical College of Virginia in 1988, Dr. Cranham maintains a strong relationship with his alma mater as an Associate Clinical Professor. He is an internationally recognized speaker on the Esthetic Principles of Dentistry, Contemporary Occlusal Concepts, Treatment Planning, Restoration Selection, Digital Photography, Laboratory Communication, and Happiness and Fulfillment in dentistry. As a published author, Dr. Cranham has a strong commitment to developing sound educational programs that exceed the needs of today’s dental professional. He is an active member of numerous professional organizations including the American Dental Association, The American Academy of Cosmetic Dentistry, The American Academy of Fixed Prosthodontics, and The American Equilibration Society. Dr. Cranham is co-chair of Advanstar Dental Media’s CE Advisory Board (Advanstar is the publisher of Dental Products Report). Dr. Cranham is the Clinical Director of The Dawson Academy where he is involved with many of the lecture and hands-on courses within the curriculum. As an active educator, he has provided over 650 days of continuing education for dental professionals throughout the world.