Dental Implant in the Smile Area - The Challenge in Dentistry

The protocol for Locally Adapted Implant Placement in the esthetic zone as a key to preventing esthetic defects

This is a procedure fraught with esthetic risks and repercussions, and for this reason it poses a challenge to dental surgeons. 

Our smile is our business card. Faulty planning or imprecise placement of an implant in the oral anterior region will have detrimental effects on the esthetic result which will be irreversible. (Faulty planning - see Figure 1)


Why does this occur mainly with implants?

In the eyes of the public, the prevailing opinion is that a dental implant functions in the mouth in the same way as a natural tooth. This idea, however, happens to be a misconception!  

As long as the natural tooth remains in the mouth the alveolar bone stays intact, without any changes occurring in structure or esthetic appearance.

After tooth extraction (due to trauma, caries or infection), significant resorption of adjacent bone ensues in both the vertical and horizontal dimensions, and this is something that the surgeon must anticipate in advance. Furthermore, gingival contraction accompanies the bone resorption during the healing phase, thus accentuating the esthetic defect.

On occasion the dentist feels obliged to choose an inclination or location site for implant placement which is unnatural, resulting in multiple negative repercussions in the esthetic outcome.

Another popular prejudice is that “replacement of the natural tooth with an implant enables preservation of alveolar bone mass”. This concept too is misguided. Research has proven that the natural process of alveolar ridge resorption continues unchecked throughout our lifetime after implant placement.


What is the solution?

These findings have led us to create a protocol which is appropriate for implant insertion in the smile zone - “The Locally Adapted Protocol”. This protocol promotes implant placement in supporting bone and gingival tissue with normal architecture. The aim of the protocol is to compensate for the bone resorption and soft tissue contraction which occur immediately following tooth extraction. This compensation is provided by implanting bone graft substitutes, along with placement of a membrane, which prevent collapse of the alveolar ridge immediately following tooth extraction.

Gingival grafting completes the task by preventing gingival recession in the future, thereby enhancing tissue mass.

By being aware of the status of the hard and soft tissues (bone and gingiva) at the surgical site, the dentist will enhance the natural, biological surroundings of the implant and reduce the risk of esthetic defects appearing in later years.

The keys to preservation of esthetics for implant placement in the smile zone are continuous attention to detail, staying updated on the latest research, experience and meticulous treatment planning.

While it is important to remember that a dental implant can never fully replace the natural tooth, it is nevertheless still possible to achieve esthetically pleasing results by means of the Locally Adapted Protocol.

Unesthetic appearance = faulty planning

The tooth preserves the alveolar bone

Bone resorption after tooth extraction, preventing dental implant placement