Joseph Kan: Peri-implant esthetics
- In order to obtain adequate facial contours, grafting should be performed at least inside the gap around the implant
- The bucco-lingual distance dictates the implant diameter, unless the mesio-distal distance is the smaller of the two
- A tunneling technique for the facial connective tissue graft helps to avoid visible incision traces and soft tissue clefts in esthetically delicate areas
- Immediate tooth replacement helps to maintain both hard and soft tissue architecture
- Tokyo 2014 symposium presentation
Immediate tooth replacement offers the benefit that the hard and soft tissue architecture can be maintained. A change in labial contours is usually occuring, so the correct management of the facial contour is crucial in order to achieve an adequate esthetic result. Dr. Kan discusses the treatment options of not grafting at all, grafting the gap that occurs around the implant and grafting both the gap and the buccal bone plate and recommends to consider the second option (to at least graft the gap). The size of the gap depends on both the socket size and the implant diameter and should be at least 1.5 mm wide in order to allow for a sufficient tissue volume. Therefore, in light of the socket size being on average around 7-9 mm, the implant diameter usually should not exceed 4.3 mm. To avoid soft tissue clefts occurring in esthetically visible areas, Dr. Kan refers to the tunneling technique for the placement of the facial connective tissue graft. Dr. Kan concludes that immediate implant placement is a difficult procedure and that in esthetically demanding areas grafting inside and outside of the socket is very important.