BEGO Semados® Esthetic Line

Aesthetic implantology

Aesthetic implantology

Which factors and knowledge are decisive for a reliable aesthetic result?

Patients' expectations of the outcome of a privately financed implant restoration have risen significantly. This increase is partly due to the increasing importance of aesthetics in society, which is significantly influenced by the strong presence in social media. Social media plays a crucial role in shaping and influencing aesthetic standards and has become a significant medium for setting trends in visual aesthetics. According to the Association of German Aesthetic Plastic Surgeons (VDÄPC), the number of cosmetic surgeries has increased by 15% [1]. Align Technologies, the manufacturer of Invisalign orthodontic aligners, is recording annual growth of 23% and has successfully treated 14.1 million patients to date. It is undeniable that the market growth of these aligners is not solely based on medical necessity, but rather on the increased patient demand for aesthetic perfection [2].

In today's society, beautiful teeth are more than ever an important status symbol. In view of the fact that patients feel well informed by various sources of information and media, it is of great importance to deal intensively with the aspects of aesthetic implantology.

Stable and predictable aesthetics are important in modern implantology

Current surgical and prosthetic approaches are designed to preserve hard and soft tissue in order to achieve optimal aesthetic integration at the implant-abutment interface. The treatment of implants in esthetically demanding areas, especially with transmucosal abutments, poses a significant challenge. Factors such as the vertical position of the implant, the orientation and bucco-lingual alignment, the height of the transmucosal tissue as well as the space for an optimised emergence profile and the dimensions of the anterior tooth to be replaced must be taken into consideration. The careful selection of the implant components and connections in terms of type, shape and dimensions, which are determined by the product range of the implant manufacturer, plays a decisive role in overcoming these challenges [3].

Key principles for increasing aesthetic success

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  1. Dental design of the prosthetics
    The profile angle near the implant-abutment connection and the emergence profile influence marginal bone loss. With an acute emergence angle of the prosthesis and a platform-switch design, marginal bone loss is minimised and peri-implantitis is avoided. [1]
  2. Adhesive joint of abutment-crown connections
    With a concave emergence profile, the adhesive joint can be placed away from the bone in order to safely remove cement residues and thus prevent peri-implantitis.
  3. Papilla stability
    For a stable papilla, the contact point of the crowns should be a maximum of 5 mm away from the crestal bone. Studies show that the papilla is almost always present if the distance between the contact point and the crest of the bone is 3-5 mm. Larger distances significantly reduce the success rate. In this case, a small contour angle protects the peri-implant tissue and ensures sufficient space for bone and soft tissue. [5], [6]
  4. Sufficient thickness of the soft tissue
    This is particularly important in the aesthetic zone. A randomised, controlled clinical study with 12-month results showed that implant restorations in the anterior region with a convex emergence profile increase the frequency of recessions. In comparison, the use of implant-supported temporaries with a concave emergence profile resulted in greater stability of the mucosal margin up to 12 months after loading. The incidence of mucosal recession was 64.3 % in the convex group, 14.3 % in the concave group and 31.4 % in the control group (straight emergence profile). Regression modelling showed that a convex profile was significantly associated with the presence of recessions compared to a concave profile (odds ratio: 12.6, 95% confidence interval: 1.82-88.48) [7]
  5. Concave abutment design
    A concave abutment design prevents thinning of the peri-implant gingiva due to pressure and facilitates cleaning. In addition, a concave emergence profile reduces the risk of peri-implantitis. [9]
  6. Subcrestal implant position and platform switch
    A subcrestal implant position in conjunction with a platform switch has a positive effect on peri-implant tissue and reduces marginal bone loss. The position of the microgap away from the bone also has a favourable effect on the dimensions of the peri-implant soft tissue. [8]
  7. Platform Switching
    The concept of platform switching limits crestal resorption and maintains the peri-implant bone level. [10]
  8. Implant spacing
    When placing implants, a distance of 1.5 mm from the teeth should be maintained, while a distance of 3 mm should be measured between two implants at the implant-abutment interface. Studies show that in addition to the vertical component, the horizontal component of the implant position is also decisive for long-term success. The distance between the abutment-implant interfaces is particularly important for subcrestal implant placement. A slim emergence profile of the abutment is important here. [4]
  9. Implant design
    An implant design that takes the platform switching concept into account can reduce circumferential bone loss and ensure a predictable aesthetic result. [11]
  10. Consideration of the biological width
    The biological width around the implant forms a barrier against bacteria and influences the remodelling of soft and hard tissue. A convex emergence profile can help to eliminate debris niches and create sufficient space for the soft tissue. [12]

"Aesthetic implantology – Which factors and knowledge are decisive for a reliable aesthetic result?“

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[1] https://www.vdaepc.de/vdaepc-statistik-2022-zahlen-fakten-entwicklungen-in-der-aesthetisch-plastischen-chirurgie/
[2] https://www.quintessence-publishing.com/deu/de/news/zahnmedizin/kieferorthopaedie/die-kieferorthopaedische-behandlung-mit-alignern-ist-ein-medizinisches-verfahren
[3] Gamborena I, Sasaki Y, Blatz MB. Transmucosal abutments in the esthetic zone: Surgical and prosthetic considerations. J Esthet Restor Dent. 2023;35(1):148-157. doi:10.1111/jerd.13006
[4] Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol. 2000;71(4):546-549. doi:10.1902/jop.2000.71.4.546
[5] Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992;63(12):995-996. doi:10.1902/jop.1992.63.12.995
[6] Puisys A, Janda M, Auzbikaviciute V, Gallucci GO, Mattheos N. Contour angle and peri-implant tissue height: Two interrelated features of the implant supracrestal complex. Clin Exp Dent Res. 2023;9(3):418-424. doi:10.1002/cre2.731
[7] Siegenthaler M, Strauss FJ, Gamper F, Hämmerle CHF, Jung RE, Thoma DS. Anterior implant restorations with a convex emergence profile increase the frequency of recession: 12-month results of a randomized controlled clinical trial. J Clin Periodontol. 2022;49(11):1145-1157. doi:10.1111/jcpe.13696
[8] Valles C, Rodríguez-Ciurana X, Clementini M, Baglivo M, Paniagua B, Nart J. Influence of subcrestal implant placement compared with equicrestal position on the peri-implant hard and soft tissues around platform-switched implants: a systematic review and meta-analysis. Clin Oral Investig. 2018;22(2):555-570. doi:10.1007/s00784-017-2301-1
[9] Soulami S, Slot DE, van der Weijden F. Implant-abutment emergence angle and profile in relation to peri-implantitis: A systematic review. Clin Exp Dent Res. 2022;8(4):795-806. doi:10.1002/cre2.594
[10] Hürzeler M, Fickl S, Zuhr O, Wachtel HC. Peri-implant bone level around implants with platform-switched abutments: preliminary data from a prospective study [published correction appears in J Oral Maxillofac Surg. 2008 Oct;66(10):2195-6]. J Oral Maxillofac Surg. 2007;65(7 Suppl 1):33-39. doi:10.1016/j.joms.2007.03.024)
[11] Calvo Guirado JL, Saez Yuguero MR, Pardo Zamora G, Muñoz Barrio E. Immediate provisionalization on a new implant design for esthetic restoration and preserving crestal bone. Implant Dent. 2007;16(2):155-164. doi:10.1097/ID.0b013e31805816c9
[12] Zheng Z (UCLA School of Dentitstry LA), Ao X, Xie P, Jiang F, Chen W. The biological width around implant. J Prosthodont Res. 2021;65(1):11-18. doi:10.2186/jpr.JPOR_2019_356
[13] Han JW, Han JW, Pyo SW, Kim S. Impact of profile angle of CAD-CAM abutment on the marginal bone loss of implant-supported single-tooth posterior restorations. J Prosthet Dent. Published online December 21, 2023. doi:10.1016/j.prosdent.2023.11.025