11/11/07 Bernard Touati taipei lecture

A biological aproach to implant esthetic tx.

slides in B&W and with video and music 

esthetics

biology

noninvasiveness

digital technology

esthetic implant dentistry --

goals :

simplify surgical procedure and less invasive and max. blood supply

80's anatomically-driven -- biomechanical concerns

90's prosthetically-driven --- emergency profile/shape concerns

2000's biologically-driven --- soft tissue architecture/stability

now

Goal to preserve adequate implant site

rethinking the software

redesigning the hardware

understanding the mucosal seal(peripheral defense)

not biological width --> instead biological space(3D)

Schuphach 2003

--- the weak link of implants ( PDL ,only transspetal fiber)

Gingival recession around implants

( a 1-year longitudinal prospective study. Int J Oral Maxillofac Implants. 2000 Jul-Aug;15(4):527-32. )

-epi .apical migartion + CT inflammation + crestal bone remodeling

Guided implantation is the trend of implantology

( computered based /modeled based )

Curvy abutment (Nobel ) -- an abutment allowing a stable biological space at its level 

anticipate 

immediate biological abutment connection --

1. after lab. customization

2.biocompatible material promotes early fibrin clot and granulation tissue 

3.impair downgrowth of Epi. 

socket preseravtion --

  1.  is the buccal plate intact ?? (partially or totally missing) 

  2.  biotype  

  3. how wide the gap is ?? 

You have to do good case selection 

Socket classification (Tarnow )

surgical template --reproduce margin 

zirconium abut. ( Glauser IJP 2004 may/june) 

papillae is related to proximal bony support ( Salama  articles) 

it's important to graft CT to counteract the recession process and to get the best esthetic outcome in the long term . (pouch procedure --less invasive) 

implant diameter selection 

  M-D(Esposito 93) implant-tooth >1.5mm 

     3mm deeper under prosthetic Gingival margin 

   B-L ( buccal bone thickness > 2mm) 

reduce bone remodeling

  polished implant neck positioned supra-crestally 

  avoid mucoperiosteal flaps

the tissue is the issue but the bone set the tone

        Atalanta team  

the issue is the soft tissue thickness

     by Tounti