Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 29

The aim of implant prosthetic rehabilitation is the integration of fixed or removable dental prostheses. Therefore, it is necessary to set up a treatment plan that considers the individual findings according to the result expected by the patient. It is important to define the surgical, prosthetic, and dental technical effort to achieve a functional and esthetic result. The amount of surgical effort required depends on the available bone and soft tissue. This effort is necessary both before and during implant insertion in order to achieve a long-term stable prosthetic result. To achieve an optimal result, detailed planning is as important as a complication-free reconstruction of the atrophied jaw and prosthetically oriented implant placement, which requires proper training in all treatment steps.⁹³

The planning of the position, number, and dimension of the implants represents the essential step for a successful restoration from an esthetic and functional point of view. The prosthetic aspects have to be considered and the available bone evaluated. Today, implants can be inserted from a prosthetic point of view as far as possible using various grafting techniques.⁸¹ Nevertheless, it is necessary to take precise account of the anatomical landmarks at the time of implant placement,⁴⁴ otherwise insufficient bony coverage of the implant surface can lead to complications such as peri-implantitis shortly after the final prosthetic delivery.²⁹ Further restrictions in terms of the functionality of the prosthetic restoration result from implant positions that require a non-physiologic tooth shape with a limited esthetic result (Fig 2-1a to d) or do not allow for sufficient hygiene maintenance (Fig 2-2a to g).⁹⁴

Fig 2-1a Long crown after deep implant placement without considering a two-stage grafting procedure.

Fig 2-1b Non-physiologic crown shape with limited oral hygiene options.

Fig 2-1c Failed implant restoration in the maxillary anterior area.

Fig 2-1d Clinical situation after removal of the crowns.

Fig 2-2a Clinical aspect of an unesthetic and unhygienic restoration.

Fig 2-2b Minimal implant distance as the cause of an unacceptable result.

Fig 2-2c Direct contact of two implants prevents the formation of interimplant soft tissue.

Fig 2-2d Panoramic radiograph documenting bad implant planning especially in the right maxilla, leading to peri-implant bone loss.

Fig 2-2e Clinical aspect of Figure 2-2d, documenting unesthetic and unhygienic restorations due to bad implant positions.

Fig 2-2f Clinical situation in the right maxilla offering inadequate cleaning possibility.