CDE0111

I 21 special _ implants I cosmeticdentistry 1_2011 treatments to perform due to the limited amount of bone and interdental space. Placing implants in the mandibular anterior region can be chal- lenging due to: 1. insufficient facio-lingual bone volume; 2. insufficient mesio-distal space between adja- cent teeth; 3. insufficient height of remaining alveolar bone; 4. thepresenceofmento-labialdepression,which limits the facio-lingual angulation of implants; and 5. the preservation or recreation of the inter- dental papilla being an extremely delicate pro- cedure. One of the prerequisites for the successful placement of an implant is the presence of ade- quate bone volume. Tarnow et al. stated that a submerged implant, following the delivery of the prosthesis, will create circumferential or hor- izontal bone resorption of 1.3 to 1.4 mm. Grunder etal. also stated that at least 2 mm of lateral alve- olar bone must be present beyond the body of the implant to compensate for the effects of bone re- modelling. If this amount of bone is not present, part or all of the facial or buccal bone plate will belostafterremodelling,withthesubsequentrisk of soft-tissue recession. This amount of bone around an implant rarely exists in the mandibular anterior region. Therefore, ridge augmentation procedures are often required to create adequate bone volume to maintain a 2 mm alveolar thick- ness following implant placement. Another prerequisite for successful implant treatment is sufficient interdental space. The creation of a natural-looking implant restora- tion largely depends on the appropriate place- ment of the implant during surgery. In order to achieve this goal, careful planning and precise implant placement are essential. An implant re- quires a minimum distance of 1.5 mm between the implant and adjacent tooth to maintain interproximal bone and interdental papilla. Stan- dard diameter implants of 4 mm or greater there- fore require a mesio-distal space of at least 7 mm to place an implant. For an interdental papilla be- tween two adjacent implants to be established, the inter-implant distance should be more than 3 mm. Thus, a minimum mesio-distal space of 14 mm is required to place two standard-diame- ter implants adjacent to each other. Implant manufacturers have introduced narrow-diameter implants (3.0 to 3.5 mm) in an attempt to solve these problems. However, these implants still require a minimum mesio-distal space of 6.0 to 6.5 mm to allow adequate im- plant-to-tooth distance. With the exception of mandibular incisors, narrow-diameter implants present a solution for the aforementioned re- quirements of adequate bucco-lingual bone volume and proper implant spacing. For missing mandibular incisors, it would be beneficial to use implants with an even smaller diameter than narrow-diameter implants. Fig. 5_Twelve weeks post-extraction. Fig. 6_Following implant placement. Fig. 7_Peri-apical X-ray at implant insertion. Fig. 8_Immediate provisionalisation. Fig. 9_Modification of provisional restoration. Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9