Aesthetics in implantology

A young man presented himself with a missing maxillary central incisor and a depressed defect due to a trauma. The trauma caused the loss of No. 8 and its surrounding supportive structure. The defective results were seen by the labial bone loss in the area and a depression. The depression became a food-and-plaque trap and an unaesthetic eyesore. Before the tooth loss, iatrogenic factors from a root canal or retrograde amalgam caused a permanent gingival tattoo. The bonded temporary pontic was larger mesio-distally than the adjacent teeth, and this was very noticeable. It was dull in its finish and poor aesthetically. The patient requested an implant to avoid excess drilling of natural teeth. A combined effort was used to achieve the pleasing final result. To correct the area and improve the physiology and aesthetics, several techniques had to be understood. These techniques also need to be mastered, recalled, and used almost instinctively, and done in a proper team-like sequence. In this case we performed an aesthetic ridge augmentation and tissue surgical manipulation to acquire the form, shape, and correct color background. Deciding upon which implant and material involved choosing the size, type, and shape for the area involved. The techniques used included implant insertion, surgical second stage abutment, mucosal periosteal flap design, various suturing and gingival grafting techniques, ridge buildup augmentation, and GTR. Other choices included which resorbable membrane to use, what bone graft materials, and what oral hygiene to recommend to maintain final health. The restorative technique included full crown coverage, laminate veneers, provisional pontic design and bonding, control of porcelain materials, computer imaging, occlusion, cementing, smile designs, and implant prosthodontics.