Treatment Planning of Implants in the Aesthetic Zone

Aesthetic restoration of anterior teeth with implant-supported restorations is one of the most difficult procedures to execute. Bone resorption following anterior tooth extraction often compromises gingival tissue levels for the implant restoration. In the last 25 years, the focus has shifted from osseointegration to creation of an implant-borne restoration, which is in harmony with the surrounding hard and soft tissue. Complete reconstruction of tooth and gingival related aesthetics remains the primary objective and, in some instances, can be very difficult to achieve. The predictability of aesthetic success depends on the tissue loss present at the initiation of treatment. The greater the amount of bone and soft tissue loss, the more difficult it becomes to produce an ideal aesthetic result. Single-tooth implants have a high degree of predictability since the adjacent teeth can provide the morphological substructure that is required to restore natural gingival and papillary architecture. Replacement of multiple missing teeth in the aesthetic zone is particularly challenging particularly when the three-dimensional architecture of the existing bone and soft tissue is deficient. The bony housing in this instance would require augmentation to provide a configuration that permits placement of implants in optimal positions, which in turn would result in pleasing aesthetics. The purpose of this chapter is to look at the diagnostic factors that affect the predictability of peri-implant aesthetics. Emphasis is placed on those parameters which are critical to overall treatment planning.