Therapeutic alternatives for addressing pink esthetic complications in single‐tooth implants: A proposal for a clinical decision tree

Abstract

Objective Esthetic complications in implant therapy today represent a clinical challenge, when the aim is to overcome the sequelae and obtain a pleasing result. The current scientific literature about this topic is scarce and often based on case reports and the personal opinions of clinicians. Clinical considerations The aim of this article is to introduce a decision tree for diagnosis and treatment of complications, focusing on the pink esthetic of single‐tooth implants and based on three diagnostic pillars (3D implant position, peri‐implant hard‐tissue anatomy, and peri‐implant soft‐tissue anatomy). Different shortcomings have been identified for each of the three diagnostic areas. Conclusions Following this tree, the article proposes treatment alternatives including soft‐ and hard‐tissue reconstruction, implant submergence, orthodontic extrusion, and implant extraction in order to help clinicians establish a logical therapeutic sequence. Clinical Significance Guidelines for adequate diagnosis and management of single implant‐supported restorations with compromised esthetics is mandatory when attempt to overcome shortcoming in the pink esthetic result.

Pontic site development with an implant submergence technique for unaesthetic implant in the anterior maxilla

“…1,2 Most clinicians agree with the opin-ion that 3-D positioning is very important in acquiring esthetics, and iatrogenic malpositioned implants are the most challenging cases. 1 An unaesthetic implant resulting from an excessive depth of placement is challenged by the long-term continued facial tissue resorption to the point of biological stability. This causes soft tissue problems, such as recession, papillae deficiency, and insufficient volume.…”

“…Esthetic complications in implant therapy represent a clinical challenge when the aim is to overcome the sequelae and obtain a pleasing result. 1 In particular, it is very difficult to correct unaesthetic problems in malpositioned implants and single implant cases because the implant integrates imperceptibly with the surrounding hard and soft tissues. 1,2 Esthetic complications related to implant therapy can be characterized into several categories according to their origin.…”

“…1 In particular, it is very difficult to correct unaesthetic problems in malpositioned implants and single implant cases because the implant integrates imperceptibly with the surrounding hard and soft tissues. 1,2 Esthetic complications related to implant therapy can be characterized into several categories according to their origin. 1,2 Most clinicians agree with the opin-ion that 3-D positioning is very important in acquiring esthetics, and iatrogenic malpositioned implants are the most challenging cases.…”

“…1,2 Esthetic complications related to implant therapy can be characterized into several categories according to their origin. 1,2 Most clinicians agree with the opin-ion that 3-D positioning is very important in acquiring esthetics, and iatrogenic malpositioned implants are the most challenging cases. 1 An unaesthetic implant resulting from an excessive depth of placement is challenged by the long-term continued facial tissue resorption to the point of biological stability.…”

“…Mesquita De Carvalho et al 1 proposed a clinical decision tree of the therapeutic alternatives of unaesthetic implant problems based on the implant position and the deficiency of hard and soft tissue: reconstruction of hard tissue and/or soft tissue, implant submergence, orthodontic forced eruption of adjacent teeth, and explantation. In the case of malpositioned implants, they proposed that explantation as the first choice of treatment.…”