New Thinking on Anterior Esthetic Implant Restorations

Natural teeth always hold and maintain bone in the mouth. When teeth are missing, the bone that remains can weaken and erode. Dental implants can fix this issue, and immediate implants are an attractive option to patients, at my own practice in New York City and other across the country, because it requires fewer visits and sees results immediately. However, sometimes implants do not work out as planned, and even though implant problems are very rare, sometimes implants need to be restored. Sometimes as well, there may not be a problem with the implant, just with the way it looks. Implant esthetics are important, issues with esthetics are very real and can cause a large amount of dissatisfaction with patients. Professionals should always be aware of this.

Although it is very exciting to be able to place immediate implants after tooth extraction in esthetically demanding situations, one must constantly be aware of the new knowledge in this field. Past thinking was that tooth removal, and immediate implant placement with bone graft completed all the necessary surgical procedures to achieve an esthetic result. Essentially it was thought that there could be no problems when using an immediate implant with a bone graft, and that esthetics would be taken care of because the original flesh and bone structure would be maintained.

Several studies have shown dimensional ridge alterations occur following tooth extraction and the buccal bone plate changes in height and width. Studies have also shown that bone grafting at the time of immediate implant placement does not completely restore the alveolar ridge. This refers to the ridge of flesh just behind the top teeth, but before the flat roof of the moth, and the ridge of flesh just behind the lower teeth. What remains is a ridge deficiency on the mid buccal aspect of the implant site. When an implant is restored in this condition, the esthetics will be compromised.

I would like to highlight a pertinent article published by Dr. Ueli Grunder, entitled:

“Crestal Ridge Width Changes When Placing Implants at the Time of Tooth Extraction With and Without Soft Tissue Augmentation After a Healing Period of 6 months: Report of 24 Consecutive Cases.” IJPRD Vol 31, Nov 2011

The article referenced above, utilized a subepithelial connective tissue graft to thicken the soft tissue thereby compensating for the loss of bone volume in the buccal dimension. They evaluated their results over 6 months and some cases a couple of years. Essentially, the professionals in the study the article references took tissue from below the outer surface. They harvested small amounts of inner tissue used to connect bone to flesh from one part of the mouth and used it to reinforce the alveolar ridge, grafting it in such a way as to mitigate the esthetic problems from immediate implants.

They concluded that the subepithelial connective tissue graft does compensate for the loss in bone volume and sustains an esthetic result over time. In my practice, I have seen the same results. Treatment planning anterior implants is complex and most often requires soft tissue grafting to achieve an esthetic result.

Patients who come to my New York City practice can be sure that they will receive the highest quality of care. I am constantly reevaluating techniques and technologies to achieve the best care, and I am persistently aware of current research. With this knowledge by Dr. Grunder in hand, I can continue to offer immediate implant services, and be sure that esthetics are not being sacrificed for expediency.

If you are in the New York City area and are looking for services that may require implant or implant restorations, call (212) 702-9088 for a consultation.