Managing esthetic challenges with anterior implants. Part 1: midfacial recession defects from etiology to resolution

Dilemmas accompanying esthetic zone implants frequently involve a dehiscence type defect of the midfacial tissues. The challenge to the surgical-restorative implant team is to understand the etiology associated with such defects and the treatment options that can be offered lending to predictable outcomes. Etiologic factors are: 1) poor implant spatial positioning; 2) incorrect abutment contour; 3) excessive implant diameter; 4) horizontal biologic width formation; and 5) periodontal phenotype. Remediation treatment can involve: 1) burying the implant and allowing the soft tissues to heal naturally over the implant with a surgical cover screw known as implant decoronation; 2) augmentation of the soft tissues with a connective tissue graft, if needed; 3) stage 2 uncovering of the implant: and 4) controlling the abutment-crown contour appropriately with flat or even undercontour to maintain the soft tissues in a stable and healthy position long term.