ITI Treatment Guide, Volume 10: Implant Therapy in the Esthetic Zone: Current Treatment Modalities and Materials for Single-tooth Replacements

This latest volume in the ITI Treatment Guide series starts out with the most recent statements and recommendations from the 5th ITI Consensus Conference, followed by a detailed protocol for the evaluation and treatment planning of patients with esthetic demands requiring single-tooth replacement with a dental implant. Various surgical situations commonly encountered in the esthetic zone are presented along with recommended treatment protocols. In addition, the many aspects of clinical management of the planned implant site (before and after placement) are discussed including the use of provisional prostheses, laboratory communication, abutment design, restorative material selection, and delivery of the definitive restoration. Fourteen complex case presentations form the core of this volume with step-by-step descriptions of procedures for achieving stable long-term esthetic outcomes. This volume provides a comprehensive, evidence-based approach to single-tooth replacement in the esthetic zone, from consultation to follow-up, with a focus on current treatment modalities and the materials that present-day implant dentistry has to offer in order to support clinicians in their decision-making processes. 444 pp; 1,386 illus Title Copyright Preface Acknowledgment Editors and Authors Contributors Table of Contents 1. Introduction 2. Consensus Statements: Statements and Recommendations Obtained from the 5th ITI Consensus Conference 2.1 Contemporary Surgical and Radiographic Techniques in Implant Dentistry 2.2 Restorative Materials and Techniques for Implant Dentistry 2.3 Optimizing Esthetic Outcomes in Implant Dentistry 2.4 Implant-loading Protocols 2.5 Prevention and Management of Biological and Technical Implant Complications 3. Preoperative Risk Assessment and Treatment Planning for Optimal Esthetic Outcomes 3.1 Patient Selection 3.1.1 SAC Classification for Single-tooth Replacement 3.2 Esthetic Risk Assessment 3.2.1 Medical Status 3.2.2 Smoking Habit 3.2.3 Gingival Display at Full Smile 3.2.4 Width of the Edentulous Span 3.2.5 Shape of Tooth Crowns 3.2.6 Restorative Status of Adjacent Teeth 3.2.7 Gingival Phenotype 3.2.8 Infection at the Implant Site 3.2.9 Soft-tissue Anatomy 3.2.10 Bone Level at the Adjacent Teeth 3.2.11 Facial Bone-wall Phenotype 3.2.12 Anatomy of the Alveolar Crest 3.2.13 Patients’ Esthetic Expectations 3.3 Treatment Planning 3.3.1 Anatomical Considerations 3.3.2 Indications for CBCT in the Esthetic Zone 3.3.3 Digital or Conventional Planning 3.3.4 Surgical Templates for Implant Placement 4. Selecting Biomaterials for Implant Procedures 4.1 Ceramic vs. Titanium Implant Materials 4.1.1 Commercially Pure Titanium Implants 4.1.2 Titanium-alloy Implants 4.1.3 Ceramic Implants 4.2 Bone Grafts and Bone Substitute Materials 4.2.1 Autologous Bone Grafts 4.2.2 Allografts 4.2.3 Xenografts 4.2.4 Alloplastic Bone Substitutes 4.3 Biologics 4.3.1 Growth Factors 4.3.2 Enamel Matrix Derivative 4.3.3 Autologous Platelet Concentrates 4.4 Membranes 4.4.1 Non-resorbable Membranes 4.4.2 Resorbable Membranes 4.4.3 New Development in Membranes with a Functionally Graded Structure 5. Surgical Considerations for Optimal Esthetic Outcomes 5.1 Post-extraction Dimensional Ridge Alterations in the Esthetic Zone 5.1.1 Flapless Low-trauma Tooth Extraction to Reduce Dimensional Alterations 5.1.2 Post-extraction Dimensional Alterations of the Hard Tissues 5.1.3 Post-extraction Dimensional Alterations of the Soft Tissues 5.2 Indications for Post-extraction Ridge Preservation 5.2.1 Ridge Preservation by Root Maintenance 5.2.2 Ridge Preservation by Socket Grafting 5.3 Indications for Soft-tissue Grafting 5.3.1 Increasing the Band of Keratinized Mucosa 5.3.2 Improving the Soft-tissue Volume 5.4 Flap Design and Suture Techniques 5.4.1 Flapless Approach 5.4.2 Elevation of a Mucoperiosteal Flap 5.5 Implant Selection 5.5.1 Selection Criteria for Soft-tissue-level (STL) vs. Bone-level (BL) Implants in the Anterior Maxilla 5.5.2 Implant Diameters in the Anterior Maxilla 5.5.3 Implant Lengths in the Anterior Maxilla 5.6 Correct Three-dimensional Implant Positioning 5.6.1 Mesiodistal Dimensions 5.6.2 Orofacial Dimensions 5.6.3 Coronoapical Dimensions 5.6.4 Implant Angulation 5.7 Surgical Approach: Simultaneous vs. Staged GBR 5.7.1 Simultaneous GBR 5.7.2 Staged GBR 5.8 Surgical Approach: Immediate vs. Early vs. Late Implant Placement 5.8.1 Immediate Implant Placement (Type 1) 5.8.2 Early Implant Placement (Type 2 and 3) 5.8.3 Late Implant Placement (Type 4) 6. Prosthetic Management for Optimal Esthetic Outcomes 6.1 Evaluation of Esthetic Outcomes in Single-tooth Replacement 6.2 Interim Prostheses 6.2.1 Before Implant Placement 6.2.2 After Implant Placement 6.3 Management of Peri-implant Tissue 6.3.1 Shaping the Transition Zone 6.3.2 Capturing the Transition Zone 6.4 Laboratory Communication 6.4.1 Photography 6.4.2 Records 6.4.3 Prescription 6.5 Screw-retained vs. Cemented Restorations 6.6 Material Selection for Abutments and Crowns 6.6.1 Prefabricated Abutments 6.6.2 Cast Custom Abutments 6.6.3 CAD/CAM Custom Abutments 6.6.4 Original vs. Non-original 6.6.5 Abutment Materials 6.6.6 Biocompatibility 6.6.7 Influence on Esthetics 6.6.8 Physical Properties 6.7 Prosthetic Design 6.7.1 Crown/Veneer Materials 6.8 Handling of Abutments and Restorations 7. Clinical Case Presentations 7.1 Replacement of a Failing Upper Left Central Incisor: Immediate Placement of an RC Bone Level Implant and Provisionalization 7.2 Replacement of a Perforated Upper Left Central Incisor: Early Placement of an RC Bone Level Implant 7.3 Replacement of an Upper Right Central Incisor with a Root Fracture: Early Placement of an RC Bone Level Implant, Variobase Abutment 7.4 Replacement of a Failing Upper Right Central Incisor: Ridge Preservation and Late Placement of a NC Bone Level Implant 7.5 Replacement of an Upper Right Central Incisor with Root Resorption: Ridge Preservation, Delayed Placement of an NC Bone Level Roxolid Implant 7.6 Replacement of an Upper Right Central Incisor with Root Resorption: Ridge Preservation, Early Placement of an RC Bone Level Implant 7.7 Replacement of an Ankylosed Central Incisor with a Gingival Recession: Tooth Extraction with Socket Grafting and Late Implant Placement with Simultaneous Contour Augmentation 7.8 Replacement of a Compromised Upper Right Central Incisor: Hard- and Soft-tissue Augmentation, Late Placement of an RC Bone Level Implant 7.9 Replacement of a Failing Restored Upper Right Central Incisor: Ridge Preservation and Early Placement of an RC Bone Level Implant 7.10 Replacement of a Fractured Upper Left Central Incisor: Delayed Placement of a Bone Level Tapered Implant Using a Staged Approach 7.11 Replacement of an Ankylosed Upper Left Central Incisor: Bone Augmentation and Socket Grafting, Late Placement of an RC Bone Level Implant 7.12 Replacement of a Missing Upper Left Central Incisor: Late Placement of an RC Bone Level Implant, CAD/CAM Zirconia Abutment 7.13 Replacement of a Missing Upper Left Central Incisor: Late Placement of an RC Bone Level Implant and Adjacent Tooth Restoration 7.14 Replacement of a Fractured Upper Left Central Incisor: Early Placement of a Monotype Zirconia Implant, Semi-submerged Transmucosal Healing 8. Esthetic Complications 8.1 Causes of Esthetic Complications 8.1.1 Incorrect 3D Implant Position 8.1.2 Implant Selection 8.1.3 Insufficient Facial Bone Wall 8.1.4 Esthetic Failure Due to Late Facial Growth 8.1.5 Esthetic Failure Due to Implants and Third-party Implant Components Lacking Scientific Validation 8.2. Management of Esthetic Complications 8.2.1 Decision Criteria for Salvaging Esthetic Implants 8.2.2 Criteria for Implant Removal 9. Conclusions 10. References Volume 10 of the ITI Treatment Guide series starts out with the most recent statements and recommendations of the 5th ITI Consensus Conference, followed by a detailed protocol for the evaluation and treatment planning of patients with esthetic demands requiring single-tooth replacement with a dental implant. Various surgical situations commonly encountered in the esthetic zone will be presented and recommendations on their treatment will be provided. In addition, the clinical management of the planned implant site before and after placement through the use of provisional prostheses, laboratory communication, abutment design, restorative material selection, and delivery will be examined. This volume of the ITI Treatment Guide series provides a comprehensive, evidence-based approach to single-tooth replacement in the esthetic zone, from consultation to follow-up, with a focus on current treatment modalities and on the materials that present-day implant dentistry has to offer. The ITI Treatment Guide series is a compendium of evidence-based implant-therapy techniques and procedures for daily practice. Written by renowned clinicians and supported by contributions from expert practitioners, the ITI Treatment Guides provide a comprehensive overview of various clinical options. The management of different clinical situations is discussed with an emphasis on sound diagnostics, evidence-based treatment concepts, and predictable treatment outcomes with minimal risk to the patient. Dental implants are used routinely throughout the world to replace missing teeth. With the broadening of treatment options and an increasing number of clinicians who provide implant therapy, it is important to ensure that the treatment methods used meet the highest clinical standards. The ITI Treatment Guide series is a compendium of evidence-based implant-therapy techniques and procedures for daily practice. Written by renowned clinicians and supported by contributions from expert practitioners, the ITI Treatment Guides provide a comprehensive overview of various clinical options. The management of different clinical situations is discussed with an emphasis on sound diagnostics, evidence-based treatment concepts, and predictable treatment outcomes with minimal risk to the patient.