Implantology in the aestethic zone is a continuous burner for every dental practitioner who tries to place implants to the patients fullest satisfaction. Professor Markus Hürzeler and Professor Hannes Wachtel, both well known implantologists from Munich/Germany, share their clinical experiences and scientific insights. In this part 1 of their lecture they talk about the best implant position, single-step- or staged approach, soft tissue management and socket preservation.
Prof. Hürzeler gives advices where the implants should be placed for an optimal and predictable aesthetic outcome. He presents facts and figures whether a single step procedure or a staged approach is indicated. Implantology in a single-step-procedure aims to preserve hard and soft tissue immediately after the extraction avoiding tissue collapse and bone resorptions. An immediate provisionalization with tooth shaped healing abutments enables the long-term stabilisation of the emergence profile. The goal of a staged implantology approach is the reconstruction of the tissue architecture and the reestablishment of the interproximal support. Several surgical treatments with Guided bone regeneration (GBR) and Guided tissue regeneration (GTR) have to be done step by step to recreate the bony and gingival architecture.
Prof. Wachtel gives a overview about the difference between soft tissue around natural teeth and implants. He describes the biology of the mucogingival complex and explains the involved factors that define the soft tissue profile. He presents the conducting biological structures of the papilla construction in which the height of the papilla and the gingival margin is determined. Prof. Wachtel has a close look to the different morphological biotypes of the gingiva in relationship to the supporting bony structures. The height of the bone crest around the implant determines the height of the papilla and the gingival margin. An adequate tissue thickness is important for the mucogingival stability around implants. Due to that surgical thickening with a connective tissue graft is avoiding esthetic failures with black triangles and a visualized implant surface.
Prof. Hürzeler explains the biology of the extraction socket and describes the resorption process in the horizontal and vertical dimension. The bundle bone into which the collagen fibres of the periodontal ligament are embedded will always be resorbed after the extraction. The stability of the important interimplant bone is discussed. In his experience immediate implant placement has no impact on the biology of the extraction socket. His advice for surgical treatments in the aesthetic zone is always to increase soft and hard tissue sufficiently for predictable and stable aesthetic results.