Interdisciplinary management of recession defects on maxillary single tooth implants: Diagnosis and treatment strategies

Abstract

Objective One of the most common complications with dental implants placed in the smile zone is the development of mid‐facial recession, creating an undesirable esthetic result. When deciding how to remediate these clinical scenarios, the question becomes whether it may be feasible to save the problematic implant or if it is more predictable to remove the implant and start all over again. However, patients may be invested emotionally, physically, and financially in the implant and remediation may be a viable option depending on the diagnosis of the specific issues at hand and multi‐disciplinary clinical execution. Clinical Significance What is crucial to understand in order to remediate these cases is answering four separate criteria: (1) is the implant in a restorable position, (2) is the implant healthy, (3) is the implant placed at an adequate depth, and (4) are components available to restore the implant. Conclusions Two different clinical reports are presented that demonstrate various treatment remedies when saving implants in the esthetic zone.

A decision‐making tree for evaluating an esthetically compromised single dental implant

“…However, in the presence of mid-facial recession with or without deficient interdental papilla, temporary implant submergence is also a viable treatment modality, as it creates an environment more amenable to augment soft tissue horizontally and vertically with a connective tissue graft, without tension, during primary closure, and to potentially restore lost papilla. 14,15,23,24 Furthermore, the utility of implant submergence is dependent upon the depth and degree of buccal placement and the need for vertical augmentation. 22 Tarnow et al emphasized the need for a presence of palatal tissue at an adequate height, providing evidence of the importance of the supracrestal tissue attachment in relation to the apico-coronal location of the implant.…”

“…As observed in the first clinical case, presence of thin, delicate interproximal papillae necessitates replacement of the crown with one of narrower dimensions to facilitate pre‐surgical coronal growth of the interproximal tissue. However, in the presence of mid‐facial recession with or without deficient interdental papilla, temporary implant submergence is also a viable treatment modality, as it creates an environment more amenable to augment soft tissue horizontally and vertically with a connective tissue graft, without tension, during primary closure, and to potentially restore lost papilla 14,15,23,24 . Furthermore, the utility of implant submergence is dependent upon the depth and degree of buccal placement and the need for vertical augmentation 22 .…”