Long-Term Esthetic Complications Associated With Anterior Implant-Supported Restorations

Having demonstrated high average survival rates, osseointegrated endosseous dental implants are considered a predictable solution for the replacement of missing teeth. Most studies and case reports have concentrated on the success and/or failure of dental implant-supported restorations in the posterior regions of the mouth, while fewer reports have investigated the performance of such treatments in the esthetic segment. Today, it is recognized that in addition to implant survival, other parameters of implant dentistry are considerations when evaluating success or failure in the esthetic zone. These include numerous patient and operator assessments of peri-implant soft-tissue level, prosthesis level, subjective smile and esthetic appearance, and phonetic changes. Implant dentistry in the esthetic zone is highly challenging because of not only the immediate postoperative appearance, but also the potential changes that might occur in the long term, such as soft- and hard-tissue recessions, infraocclusion of single implants adjacent to natural teeth, and the unpredictable development of peri-implantitis. Thus, the aim of this article is to identify possible long-term biologic complications that may develop around dental implant in the esthetic zone and discuss their effect on treatment decisions.