Case Reports Of Multiple Adjacent Dental Implants Restoration In The Esthetic Zone

Objective: The use of dental implants in the esthetic zone is well documented in the literature.Numerous controlled clinical trials have shown that the overall implant survival and success rates involved are similar to those reported for other indications.However,the success rates were significantly reduced when esthetic parameters were measured in the actual success of the implant treatment.This paper introduces the treatment process of multiple adjacent dental implants restoration in the esthetic zone,discusses the technology for surgery and restoration of implant,summarizes the clinical experience of obtaining good esthetic effect in esthetic zone.It can provide some reference for the future clinical implant esthetic treatment.Materials and Methods: We selected 5 patients who were treated in the implant center of Dalian Stomatological Hospital Affiliated to Dalian Medical University from November 2014 to February 2016,they were people with extended edentulous spaces in the esthetic zone.First,we asked the patient history and did the oral examination,took the CBCT examination to measure the area of available bone,assessed the risk of esthetic,used computer assisted software to analysis the three dimensional of implantation,and then we communicated with patients and made the final implant treatment plan.Also we told them all the risks.We did the Onlay graft before implant placement or GBR with the implant surgery when the bone and soft-tissue volume is deficient both vertically and horizontally in multi-tooth edentulous area.We took the immediate implant placement and immediate restoration when they are meeting immediate implant or immediate repair indication.On the contrary,the dynamic compression technique is therefore recommended in the esthetic zone using screw-retained provisional restorations.After osseointegration,soft tissue was well shaped and stable,custom-made transfer coping was taken to give technician precise soft tissue information.At last,customized zirconia abutments and all-ceramic crowns were fabricated to complete the permanent restoration for multiple implants.These five typical cases include 10 bone level implants,4 for Straumann and 6 for BEGO.Onlay graft was used in 2 cases,3 cases took immediate implant placement and 2 cases did the immediate restoration.Results: Ten bone level implants were placed in these 5 patients with multiple adjacent dental implants restoration in the esthetic zone.After 10 to 16 months' clinical observation,all of the implants had obtained good osseointegration and had no significant pathological bone resorption,also playing function well.Onlay graft or GBR is an effective and reliable method to restore the alveolar bone defects for dental implantation.Based on the strict control of indication,immediate implant placement and immediate restoration after minimally invasive extraction in upper anterior teeth can achieve good clinical effect,especially esthetic effect.After soft tissue was well shaped and stable,using custom-made transfer coping to give technician precise soft tissue information is a predictable technique.All patients were satisfied with the outcomes.Conclusion: Patients with implant-supported restorations in extended edentulous areas in the esthetic zone are usually demanding and fall into the categories of “advanced” or“complex” of the classification used by ITI.They are the most challenging clinical treatment programs and are commonly associated with deficiencies of the alveolar bone or soft tissues.Before implant treatment of multiple adjacent teeth,meticulous treatment planning and risk assessment are mandatory,and the results must be matched with each clinician's individual expertise,optimizing the chances for successful shortern and long-term outcomes.In most instances,a team approach involving a surgeon, prosthodontist,and laboratory technician is required,taking advantage of the broadest possible level of knowledge and skills with ideal utilization of the available(bio)materials,technologies,and techniques.Onlay graft or GBR can effectively restore the alveolar bone defects for better dental implantation.Immediate implant placement and immediate restoration can achieve good esthetic effect.Esthetic technology including the use of screw-retained provisional restorations and customized zirconia abutments and all-ceramic crowns can offer excellent esthetic outcomes.