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Multidisciplinary approach of the problem of unaesthetic implants in the maxillary anterior dentition

비심미적 임플란트의 심미성 회복을 위한 다각적 접근법

  • Joo, Ji-Young (Department of Periodontology, Pusan National University Dental Hospital) ;
  • Choi, Jeomil (Department of Periodontology, School of Dentistry, Pusan National University) ;
  • Lee, Ju-Youn (Department of Periodontology, School of Dentistry, Pusan National University)
  • 주지영 (부산대학교치과병원 치주과) ;
  • 최점일 (부산대학교 치의학전문대학원 치주과학교실) ;
  • 이주연 (부산대학교 치의학전문대학원 치주과학교실)
  • Received : 2015.03.10
  • Accepted : 2015.05.31
  • Published : 2015.06.30

Abstract

Periodontal tissue destroyed by inflammation is difficult to achieve regeneration of the tissue and esthetic restorations only by surgical methods. In particular, improvement of esthetics is more difficult if the problem is related to the implant. A 23 year old woman suffered from unesthetic anterior implant prosthesis. According to her dental history, a repeated bone graft and soft tissue graft failed at a local dental clinic. It was needed to resolve the inflammation and to improve the esthetics. A free gingival graft and ridge augmentation accompanied by guided bone regeneration and a vascularized interpositional periosteal connective tissue graft was performed. Instead of implant prosthesis, a conventional fixed bridge was adopted for better esthetic result. The patient was satisfied with the esthetic conventional fixed prosthesis. This case report introduces esthetic rehabilitation of unesthetic implant prosthetics in the maxillary anterior dentition by a combination of surgical and prosthetic approaches.

염증에 의해 파괴된 치주조직은 외과적 방법만으로 조직의 완전한 재생과 심미수복을 이루는 것이 어렵다. 특히, 임플란트와 관련된 문제라면 심미성의 향상을 얻기가 더욱 어렵다. 23세 여자 환자가 비심미적인 전치부 임플란트 보철물을 개선하고자 내원하였다. 개인 치과의원에서 수차례 치조골 이식술과 연조직 이식술을 받았으나 실패한 상태였다. 염증을 제거하고 심미성을 향상시키기 위해 유리치은이식술 시행 후 골유도재생술과 혈관개재 골막결합조직 이식술(vascularized interpositional periosteal connective tissue graft)을 이용한 치조제증대술을 시행하였다. 심미적 보철물 제작을 위해 임플란트 지지형 보철물 대신 인접 자연치를 이용한 전통적인 고정성 보철물을 선택하였다. 상악 전치부 치열에서 비심미적인 임플란트 보철물을 외과적 그리고 보철적 접근을 통한 다각적 방법을 병용함으로써 더 우수한 심미성을 회복한 증례를 소개하고자 한다.

Keywords

References

  1. Froum SJ, Rosen PS. A proposed classification for peri-implantitis. Int J Periodontics Restorative Dent 2012;32:533-40.
  2. Wennstrom JL, Bengazi F, Lekholm U. The influence of the masticatory mucosa on the periimplant soft tissue condition. Clin Oral Implants Res 1994;5:1-8. https://doi.org/10.1034/j.1600-0501.1994.050101.x
  3. Le B, Burstein J. Esthetic grafting for small volume hard and soft tissue contour defects for implant site development. Implant Dent 2008;17:136-41. https://doi.org/10.1097/ID.0b013e318174db99
  4. Jovanovic SA. The management of peri-implant breakdown around functioning osseointegrated dental implants. J Periodontol 1993;64:1176-83. https://doi.org/10.1902/jop.1993.64.11s.1176
  5. Lindhe J, Meyle J; Group D of European Workshop on Periodontology. Peri-implant disease: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol 2008;35:282-5. https://doi.org/10.1111/j.1600-051X.2008.01283.x
  6. Heitz-Mayfield LJ, Mombelli A. The therapy of peri-implantitis: a systematic review. Int J Oral Maxillofac Implants 2014;29:325-45. https://doi.org/10.11607/jomi.2014suppl.g5.3
  7. Araujo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 2005;32:212-8. https://doi.org/10.1111/j.1600-051X.2005.00642.x
  8. Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19:43-61.
  9. Salama H, Salama M. The role of orthodontic extrusive remodeling in the enhancement of soft and hard tissue profiles prior to implant placement: a systematic approach to the management of extraction site defects. Int J Periodontics Restorative Dent 1993;13:312-33.
  10. Harper KA. Submerging an endodontically treated root to preserve the alveolar ridge under a bridge-a case report. Dent Update 2002;29:200-3. https://doi.org/10.12968/denu.2002.29.4.200
  11. Simons AM, Darany DG, Giordano JR. The use of free gingival grafts in the treatment of peri-implant soft tissue complications: clinical report. Implant Dent 1993;2:27-30. https://doi.org/10.1097/00008505-199304000-00006
  12. Steinemann SG. Titanium-the material of choice? Periodontol 2000 1998;17:7-21. https://doi.org/10.1111/j.1600-0757.1998.tb00119.x
  13. Kreisler M, Kohnen W, Christoffers AB, Gotz H, Jansen B, Duschner H, d'Hoedt B. In vitro evaluation of the biocompatibility of contaminated implant surfaces treated with an Er:YAG laser and an air powder system. Clin Oral Implants Res 2005;16:36-43.
  14. Singh G, O'Neal RB, Brennan WA, Strong SL, Horner JA, Van Dyke TE. Surgical treatment of induced peri-implantitis in the micro pig: clinical and histological analysis. J Periodontol 1993;64:984-9. https://doi.org/10.1902/jop.1993.64.10.984
  15. Wetzel AC, Vlassis J, Caffesse RG, Hammerle CH, Lang NP. Attempts to obtain re-osseointegration following experimental peri-implantitis in dogs. Clin Oral Implants Res 1999;10:111-9. https://doi.org/10.1034/j.1600-0501.1999.100205.x
  16. Froum SJ, Froum SH, Rosen PS. Successful management of peri-implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3- to 7.5-year follow-up. Int J Periodontics Restorative Dent 2012;32:11-20.
  17. Hurzeler MB, Quinones CR, Morrison EC, Caffesse RG. Treatment of peri-implantitis using guided bone regeneration and bone grafts, alone or in combination, in beagle dogs. Part 1: Clinical findings and histologic observations. Int J Oral Maxillofac Implants 1995;10:474-84.
  18. Hurzeler MB, Quinones CR, Schupback P, Morrison EC, Caffesse RG. Treatment of peri-implantitis using guided bone regeneration and bone grafts, alone or in combination, in beagle dogs. Part 2: Histologic findings. Int J Oral Maxillofac Implants 1997;12:168-75.
  19. Sclar AG. The vascularized interpositional periosteal-connective tissue (VIP-CT) flap. In: Sclar AG, editor. Soft tissue and esthetic considerations in implant therapy. Florida; Quintessence; 2003. p. 205-21.
  20. Poqqio CE, Salvato A. Implant repositioning for esthetic reasons: a clinical report. J Prosthet Dent 2001;86:126-9. https://doi.org/10.1067/mpr.2001.117054