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 2 of their lecture Dr. Otto Zuhr, also Munich/Germany, joins them to present clinical cases with different levels of difficulty. They give examples for clinical situations that will end up predictable or with esthetic failure. Due to their experience they enroll a clinical classification system staging the diagnostic outcome in four types.
In the beginning Prof. Hürzeler, Prof. Wachtel and Dr. Zuhr present cases with an intact hard and soft tissue. In this clinical situation a flapless single step implantology procedure can be carried out with immediate provisionalization. Patients with a thin biotype should be treated previously with a staged approach to thicken the soft tissue complex. The morphological biotype has to be switched with a connective tissue graft to avoid recessions and a visible, shiny implant surface. After a healing period the extraction and implant insertion can take place in one visit. Orthodontic extrusions with a magnet enable the vertical decrease of the buccal bone and the gingival margin.
The elastic fibres are stretched with the orthodontic advice. Due to that a long retention phase is necessary. Otherwise the elastic fibres are banding back when the soft tissue is detached during the extraction procedure. In complex cases with loss of hard and soft tissue and thin biotype a CT-scan enables an optimized implant placement. Guided surgery with a radiographic template offers minimally invasive flapless procedures. The three-dimensional computerized navigation system can be combined with individual Guided bone regeneration (GBR) and Guided tissue regeneration (GTR) to thicken the hard and soft tissue volume for a long-lasting and esthetic implant loading.
A customized impression copy of the emergence profile creates an integrated and stable gingival complex. The distraction osteogenesis technique enables vertical bone augmentation in front teeth regions with progressive bone loss. In some cases the best decision might be a bridge. In the future the implantology technique has to develop a way to deal with borderline situations in difficult operation sites in the esthetic zone succesfully. It is necessary to give the patient realistic expectations. The classification systems of the three experts - based on actual studies and scientific implantology outcome - helps to find the best decision.