Many challenges are encountered in restoring the esthetic zone with implants. These challenges are prosthetic, surgical and psychological. Among the prosthetic are prosthetic designs and implant location. The surgical includes available bone, bone density, anatomical obstacles, general medical conditions, and immediate implants. The psychological aspects of the patient include age, occlusal factors, oral hygiene, and psychological type.
One of the most important prerequisites for achieving and maintaining successful osseointegration is the presence of a sufficient volume of healthy bone at the recipient site. This includes not only bone of sufficient height to allow the insertion of an implant of appropriate length but also a ridge of sufficient crest width. Clinical studies have shown that implants placed in a site with a missing buccal bone wall have a greater rate of soft tissue complications and a compromised long-term prognosis. To avoid implant complications, these studies suggested that sites with inadequate bone volume either should be considered local contraindications to implant placement or should be locally augmented with an appropriate surgical procedure to regenerate the bone and allow implant placement.
Different indications, numerous alternative techniques, and various “biologically active” agents and biomaterials are currently used to augment bone. Each type of augmentation material may be used in combination with a variety of different surgical techniques, so many permutations of treatment are possible, and the situation is rather complicated. In addition, new techniques and “active agents” are continuously introduced in clinical practice.
This presentation will discuss these entire alternatives with special emphasis on the therapeutic and diagnostic challenges and prosthetically-driven implant placement concept.