Transmucosal abutments in the esthetic zone: Surgical and prosthetic considerations

Abstract

Objective: This article describes an updated step-by-step protocol for transmucosal abutment selection and treatment sequencing after immediate implant placement in the esthetic zone.Clinical Considerations: Current surgical and prosthetic concepts strive to preserve hard and soft-tissues to provide optimal esthetics at the implant-abutment interface.Consequently, restoring implants in the esthetic zone with transmucosal abutments presents a great challenge and must take into consideration implant depth, angulation, and bucco-lingual position as well as transmucosal height and space for an optimized emergence profile of the restoration and the dimensions of the anterior tooth to be restored. The proper selection of the type, shape, and dimensions of implant components and connections, determined by the product portfolio offered by the implant manufacturer, play a critical role in the ability to adequately address these challenges. This article provides an update on surgical and prosthetic workflows for single implant restorations in the esthetic zone.Conclusions: Following esthetic, mechanical, and biologic principles, the long-term success of implant-supported restorations in the esthetic zone is directly correlated to proper execution and sequencing of surgical and prosthetic treatment steps, especially after immediate implant placement. These steps must be critically assessed based on the current scientific evidence to achieve the desired clinical outcomes on a predictable and consistent basis.Clinical Significance: Selection of surgical and prosthetic treatment protocols to achieve ideal esthetic outcomes and emergence profiles in implant dentistry is often a great challenge, not only determined by technical and clinical skills of the provider but also by the type and dimensions of implant components and connections offered by the manufacturer. Following certain decision-making principles and workflows are key for clinical success with implant-supported restorations after immediate implant placement the esthetic zone.

Preservation of Socket for Immediate Dental Implants in Aesthetic Zone from Upper Jaw: Aesthetic Approach-Case Report

“…The design and shape of the second lever arm are specifically crafted to minimize trauma to surrounding tissues and structures. The elevator's blade or tip is usually thin and tapered to fit into the space between the tooth and the bone without causing excessive damage or trauma preserving the structure of the socket (3,4). Different authors like Park et al recommended the use of immediate implant placement because preservation of bone and soft tissue, reduced treatment time, improved esthetics, increased functional stability, enhanced patient satisfaction and can be cost-effective compared to delayed placement, as it eliminates the need for additional bone grafting procedures and reduces the overall treatment time.…”

Effects of socket‐shield therapy on inter‐implant papilla preservation between upper central and lateral incisors: A case series with 3–5 year follow‐up

“…The lack of complete papilla filling in the embrasure space in the esthetic zone can raise concerns, potentially jeopardizing cosmetic results 4,5 . Various factors, including the bone level of the adjacent tooth, the vertical distance from the contact point to the ridge crest, soft tissue phenotype, keratinized gingiva, surgical procedure, provisionalization protocol, and abutment crown shape influence the dimensions of peri‐implant papillae 6–14 …”

“…4,5 Various factors, including the bone level of the adjacent tooth, the vertical distance from the contact point to the ridge crest, soft tissue phenotype, keratinized gingiva, surgical procedure, provisionalization protocol, and abutment crown shape influence the dimensions of peri-implant papillae. [6][7][8][9][10][11][12][13][14] In cases involving early and immediate implants, it is common for the distal papilla to exhibit greater insufficiency and lower PES compared to the mesial papilla. 2,15,16 Thus, despite favorable soft tissue cosmetic outcomes around single central incisor implants, papillary insufficiency on the distal aspect can result in detectable esthetic imperfection.…”