In the last few years the aesthetic result of the final prosthetic restoration has become one of the most fascinating challenge in implant dentistry. As a matter of fact, the implant position is now driven more by the prosthetic request than by the quantity and the morphology of the available bone.
The introduction of the biological concepts of Guided Bone Regeneration (GBR) in the last 10-15 years has determined a major improvement in the aesthetic outcomes.
A correct diagnosis based on a multidisciplinary approach, including periodontal, prosthetic and surgical parameters is crucial. The periodontal evaluation must consider different factors regarding the patient’s periodontal health and anatomy like the periodontium bio-type, amount of cheratinized gingiva and mucosa, the height and the width of available bone.
The prosthetic treatment planning has to consider cosmetics, phonetics and function.
The implant placement in a proper position is essential for at least four reasons:
(1) the emerging profile of the final prosthetic restoration is influenced by the position of the implant;
(2) a sufficient amount of bone must be maintained buccally, mesially and distally to the implant;
(3) there must be a minimal discrepancy between the axis of the crown and the axis of the fixture;
(4) A proper biological width must be respected.
The regenerative techniques have been recently improved with the introduction of more effective barrier membranes, osteoconductive biomaterials, and the development of surgical procedures. This techniques, allowing bone regeneration vertically in a coronal direction, determined a substantial improvement in the final aesthetic outcomes.