Several factors influence the aesthetic and functional success of anterior dental implants, above all in the upper jaw.
In these cases, the dental prosthesis has enormous aesthetic repercussion given that it participates in the harmony and appearance of the smile. At our dental clinic in San Sebastian we consider this combination of practicality and aesthetics to be essential.
The patient’s aesthetic demands
Before starting, we talk with the patient to find out what results they expect, i.e. whether they only want to be able to eat properly or whether they want to improve the look of their smile. To offer the process most suited to each patient, it is important to know the different odontology specialities, since often a multidisciplinary approach is required.
The patient may require tooth whitening, gum treatment or adaptation, porcelain veneers, dental implants with ceramic crowns, and even orthodontics. They may need a single treatment, or several at the same time.
The soft tissues
The patient’s gums must be in good condition and, if possible, thick, so that they surround the porcelain crowns on implants in the anterior aesthetic area. This will prevent the gum from receding and exposing the metal head of the implant. It is essential that they have good dental hygiene habits and, if not, that they start to use them.
The bone base
To fit dental implants a scan will always be made to establish the bone height, width and density, as well as to analyse potential alterations in the adjacent teeth, studied in a preliminary X-ray.
The adjacent teeth
We will study the state of health, colour and shape of the teeth, also making an aesthetic analysis of the patient’s full set of teeth.
Habits and general diseases
Alcohol and tobacco have a negative effect on gums, on the prognosis of dental implants, and on maintenance of the aesthetics achieved with the treatment we propose.
Oral clinical background
We need to know the cause or causes of why the patient has lost the teeth we plan to replace with implants. They may have suffered a periodontal or general underlying disease, have bad oral hygiene habits or smoke and drink. If we don’t correct the causes, our treatment may also fail.
This is the achieving of good looking teeth with respect to their colour and size, proportional to one another and to the gums, the lips and the rest of the face. The diagnostic wax model is therefore important. This is the model taken from the plaster cast model reproducing the mouth, made in white and pink wax and showing the new teeth and their gums. If correctly presented, the patient will have a better idea of the treatment/s we propose.
Success factors in aesthetic implantology
Keratinised gum around the tooth
A thick keratinised gum around the implant seals it in and prevents entry by the bacteria responsible for producing periodontitis. Similarly, a thick gum stays stable around the ceramic teeth and does not recede.
If there is no keratinised gum, it can be created by means of a graft. And if there is very little, which generally occurs in the distal zones of the jaw, it must be sectioned to leave half in the external part, and the other half in the internal part.
In the case of post-extraction implants in anterior teeth, in addition to filling the external gap with Bio-Oss, the gum should be thickened with a conjunctival graft carried out at the same time.
Adequate selection of the case and of the patient
It is important to fit the number of implants necessary to ensure that the dental prosthesis will remain in place with time, with no overload on the implants or on the bone that supports them. At our dental clinic in San Sebastian, a dentist specialising in dental implants will study the patient’s health and hygiene habits.
Appropriate Surgical Technique
The dentist carrying out the implant surgery, particularly in cases of scarce bone or aesthetic compromise, must have excellent knowledge of implantology and place the implants in the adequate position for the dental prosthesis they intend to fit.
The operation will take place in conditions of perfect asepsis. The implants must not be placed too close to one another as sufficient supporting bone is required between them. Immediate load implants come at a great risk of loss, particularly if they are carried out after extraction, i.e. immediately after the root is extracted.
They can sometimes function on the upper jaw in single-root teeth. It is better not to attempt them on the lower jaw. Implants must not be fitted with a view to subsequently joining them prosthetically with a bridge to the patient’s natural teeth. Account must be taken of the fact that the implant is to be screwed to the bone, while a natural tooth has a periodontal ligament around the root, giving it a certain amount of movement. This difference in movement may cause loss of the implant or of the natural tooth to which it is joined.
Preparation of the dental prosthesis
The implant impressions must be taken with high quality silicone. These impressions are then transformed into a plaster cast model reproducing the mouth and the implants. The model is then scanned, and the prosthesis made using the CAD-CAM technique.
Tests are made on the structure connecting the implants, which must fit into them gently, without stress. This is known as passive fit, whereby the little screws connecting the ceramic teeth to the implants are fully screwed in, with no stress. If the coupling requires force, the impressions and the structure must be repeated. After a good fit of the internal structure, in the case of one or two implants, the ceramic crown is fitted and tested.
If there are several teeth and implants, an aesthetic test is carried out with resin teeth mounted on wax, to check the aesthetics and correct the shape and position of the teeth if necessary. If the dentist is happy with the aesthetic test, the final prosthesis can be made.
In order that the implants last in time and continue to look good, the prosthesis must be made by a dentist with clinical experience and good knowledge of smile aesthetics. Furthermore, the prosthetic materials and laboratory must be of good quality. At our Dental Clinic we scrupulously observe these Quality Criteria.