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Case Presentation: A Multifaceted Approach to Complex Restorations

Treatment Planning A Complex Implant Case
Launch Course

Course Objectives (1 CE Credit)

Siamak Abai, DDS, MMedSc

The tools, technology and restorative protocols offered by modern implant dentistry allow clinicians a wide range of treatment options when approaching implant restorations. This clinical flexibility is crucial when restoring a complex implant case. Comprehensive treatment plans can be developed that utilize varied methods to accommodate the individual patient’s anatomy, bone width, soft-tissue characteristics and esthetic considerations.

The esthetic challenges of each case can be addressed by selecting a surgical approach that places the implant in the optimal position for the final prosthesis. The soft tissue and interdental papillae can be carefully managed with custom components during healing to create an esthetic emergence profile for the final restoration. Achieving an optimal result in complex implant cases can require sequential treatment that combines a variety of clinical techniques and protocols. Topics include:

  • Clinical parameters for choosing freehand vs. guided surgery
  • Maximizing esthetic outcomes with sequential treatment planning
  • The use of ovate pontics in developing soft-tissue contours
  • The role of CBCT and intraoral scanning in digital treatment planning cases
  • Designing surgical guides to optimize implant placement
  • Utilizing custom provisionals to control gingival anatomy during healing
  • Properly positioning implants to maximize restorative outcomes
  • Utilizing multi-unit temporaries to contour soft tissue across multiple implant sites
  • The applications of cement- and screw-retained restorations
  • Immediate loading and proper determination of initial implant stability
  • Managing soft tissue to facilitate an optimal emergence profile for the final restoration
  • Establishing consistent esthetics in cases involving multiple restorations

Summary

There are a wide variety of clinical options to consider when treatment planning a complex implant case. In order to meet patient needs and satisfy anatomic considerations, it is sometimes necessary to adopt a sequential, comprehensive approach that leverages various treatment protocols and techniques. Treatment plans can be adjusted as cases progress and a better understanding of patient anatomy is attained.

Whichever approach is adopted, custom healing and provisional components help to maximize final outcomes by contouring the soft tissue for an esthetic final restoration. When restoring a complex implant case, clinicians can achieve excellent results by utilizing a multi-faceted approach that incorporates disparate treatment modalities in order to meet the needs of the individual patient.

CAUTION: When viewing the techniques, procedures, theories and materials that are presented, you must make your own decisions about specific treatment for patients and exercise personal professional judgment regarding the need for further clinical testing or education and your own clinical expertise before trying to implement new procedures.


References

  1. Nokar S, Moslehifard E, Bahman T, Bayanzadeh M, Nasirpouri F, Nokar A. Accuracy of implant placement using a CAD/CAM surgical guide: an in vitro study. Int J Oral Maxillofac Implants. 2011 May-Jun;26(3):520-6.
  2. Kinsel RP, Lamb RE. Tissue-directed placement of dental implants in the esthetic zone for long-term biologic synergy: a clinical report. Int J Oral Maxillofac Implants. 2005 Nov-Dec;20(6):913-22.
  3. Block MS, Mercante DE, Lirette D, Mohamed W, Ryser M, Castellon P. Prospective evaluation of immediate and delayed provisional single tooth restorations. J Oral Maxillofac Surg. 2009 Nov;67(11 Supply):89-107.
  4. Kourtis S, Psarri C, Andritsakis P, Doukoudakis A. Provisional restorations for optimizing esthetics in anterior maxillary implants: a case report. J Esthet Restor Dent. 2007;19(1):6-17.
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