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Pontic site development with an implant submergence technique for unaesthetic implant in the anterior maxilla

상악 전치부 임플란트의 비심미성 개선을 위한 임플란트 침수(submergence)를 동반한 치조제 증대술

  • Song, Yujeong (Department of Periodontology, Pusan National University Dental Hospital) ;
  • Lee, Ju-Youn (Department of Periodontology, School of Dentistry, Pusan National University)
  • 송유정 (부산대학교치과병원 치주과) ;
  • 이주연 (부산대학교 치의학전문대학원 치주과학교실)
  • Received : 2020.09.29
  • Accepted : 2020.11.02
  • Published : 2020.12.31

Abstract

Improving implant esthetics is very difficult, especially in cases where unaesthetic problems are related to implants in the maxillary anterior dentition. A 69-year old male patient was referred by a prosthodontist for periodic pus discharge and an unaesthetic implant prosthesis (maxillary right lateral incisor). The implant was placed too deeply and showed soft tissue volume deficiency and a long clinical crown. After a clinical and radiographic examination, implant submergence and alveolar ridge augmentation were performed to enhance the aesthetics instead of an explantation. The treatment plan was as follows: extraction the adjacent teeth with tooth mobility, secondary caries, and poor prognosis; placement an additional dental implant with hard and soft tissue grafting; fabrication a fixed bridge using implant abutments. A fixed esthetic prosthesis using implants was fabricated, and the patient was satisfied with the prosthesis. A ridge augmentation with implant submergence may be an alternative for solving the problems of unaesthetic implant restorations in the esthetic zone.

비심미적인 임플란트유지형 보철물의 심미성 개선은 매우 어려운 문제이며 특히, 상악 전치부 임플란트와 관련되어 있는 경우는 더욱 그러하다. 본 증례는 상악전치부 임플란트의 주기적 배농과 비심미성을 주소로 보철과의사로부터 의뢰된 69세 남자 환자의 심미성 개선에 관한 보고이다. 임플란트는 다소 깊게 식립되어 긴 임상치관길이를 보였으며, 주변 연조직 양도 부족하였다. 임상 검사와 방사선검사 후, 깊게 식립된 임플란트의 제거 대신 예후가 불량한 인접 치아의 발치 후 임플란트를 추가 식립하여 임플란트 유지형 고정성보철물을 제작하고, 깊게 식립된 임플란트는 제거 대신 치조제 증대에 도움을 주기 위해 침수(submergence)시켜 치조제를 증대시키는 방식을 선택하였다. 적절한 진단이 동반된 임플란트 침수가 전치부의 임플란트 비심미성을 개선시킬 수 있는 또다른 대안이 될 수 있을 것이다.

Keywords

References

  1. Mesquita de Carvalho PF, Joly JC, Carvalho da Silva R, Gonzalez-Martin O. Therapeutic alternatives for addressing pink esthetic complications in singletooth implants: A proposal for a clinical decision tree. J Esthet Restor Dent 2019;31:403-14. https://doi.org/10.1111/jerd.12487
  2. Cooper LF, De Kok IJ, Thalji G, Bryington MS. Prosthodontic Management of Implant Therapy: Esthetic Complications. Dent Clin North Am 2019;63:199-216. https://doi.org/10.1016/j.cden.2018.11.003
  3. Buser D, Dula K, Belser UC, Hirt HP, Berthold H. Localized ridge augmentation using guided bone regeneration. II. Surgical procedure in the mandible. Int J Periodontics Restorative Dent 1995;15:10-29.
  4. Grunder U. Crestal Ridge Width Changes When Placing Implants at the Time of Tooth Extraction With and Without Soft Tissue Augmentation After a Healing Period of 6 Months: Report of 24 Consecutive Cases. Int J Periodontics Rest 2011;31:9-17.
  5. Comut A, Mehra M, Saito H. Pontic site development with a root submergence technique for a screw-retained prosthesis in the anterior maxilla. J Prosthet Dent 2013;110:337-43. https://doi.org/10.1016/j.prosdent.2013.06.009
  6. Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res 2012;91:242-8. https://doi.org/10.1177/0022034511431252
  7. Joo JY, Son S, Lee JY. Implant Site Development for Enhancing Esthetics of Soft and Hard Tissue and Simplification of Implant Surgery Using a Forced Eruption. Int J Periodontics Restorative Dent 2016;36:583-9. https://doi.org/10.11607/prd.2291
  8. Kan JY, Rungcharassaeng K, Lozada JL, Zimmerman G. Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year followup. Int J Oral Maxillofac Implants 2011;26:179-87.
  9. 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 Suppl:43-61.
  10. Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 2008;19:73-80. https://doi.org/10.1111/j.1600-0501.2007.01413.x
  11. Funato A, Salama MA, Ishikawa T, Garber DA, Salama H. Timing, positioning, and sequential staging in esthetic implant therapy: a four-dimensional perspective. Int J Periodontics Restorative Dent 2007;27:313-23.
  12. Chackartchi T, Romanos GE, Sculean A. Soft tissue-related complications and management around dental implants. Periodontol 2000 2019;81:124-38. https://doi.org/10.1111/prd.12287
  13. Mombelli A, Lang NP. The diagnosis and treatment of peri-implantitis. Periodontol 2000 1998;17:63-76. https://doi.org/10.1111/j.1600-0757.1998.tb00124.x
  14. Januario AL, Barriviera M, Duarte WR. Soft tissue cone-beam computed tomography: a novel method for the measurement of gingival tissue and the dimensions of the dentogingival unit. J Esthet Restor Dent 2008;20:366-73. https://doi.org/10.1111/j.1708-8240.2008.00210.x
  15. Gonzalez-Martin O, Oteo C, Ortega R, Alandez J, Sanz M, Veltri M. Evaluation of peri-implant buccal bone by computed tomography: an experimental study. Clin Oral Implants Res 2016;27:950-5. https://doi.org/10.1111/clr.12663
  16. 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
  17. 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. https://doi.org/10.1111/j.1600-0501.2004.01056.x
  18. 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
  19. Salama M, Ishikawa T, Salama H, Funato A, Garber D. Advantages of the root submergence technique for pontic site development in esthetic implant therapy. Int J Periodontics Restorative Dent 2007;27:521-7.