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Soft tissue Considerations in Osseointegrated Supported Prosthesis

by Dr. Arunoday Kumar, Dr. Priyaranjan, Dr. Rajesh. S. Nongthombam, Dr. Manjula Das, Dr. Sandeep Kumar, Dr. Syeda Shamima Nastaran Quazi

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CONTENTS

Authors Information:

Dr. Arunoday Kumar, Assistant Professor in the Department of Prosthodontics and Crown & Bridge including Implantology at Dental College, RIMS, Imphal. He has done his dental graduation (B.D.S) from Manipal University (M.C.O.D.S., Mangalore) and finished his M.D.S from NITTE University (A.B.S.M.I.D.S, Derlakatte, Mangalore). He has numerous research paper publications in various indexed national and international journals. He is a well trained academician and has seven years of teaching and research experience in the field of dentistry.

Dr. Priyaranjan, MDS, Public Health Dentistry

Dr. Rajesh. S. Nongthombam, Associate Professor, Department of Prosthodontics and Crown & Bridge, Dental College RIMS, Lamphelpat, Imphal West, Manipur. He has done BDS from Guwahati University (RDC, Guwahati, India) and completed his MDS from KGMC, Lucknow, India. He has  a number of national and international publications to his credit and has got more than 10 years of teaching experience till date.

Dr. Manjula Das is working as a Reader in the Department of Prosthodontics and Crown & Bridge, Regional Dental College, Guwahati.  She is a renowned academician and actively associated with undergraduate and postgraduate teachings and has a number of  indexed national and international publications to her credit. She has completed BDS and MDS from Regional Dental College in the specialty of Prosthodontics. She was an elected member of Dental Council Of India from North East Region. She was also the president of IDA, Assam State Branch.

Dr. Sandeep Kumar, is working in the Department of Public Health Dentistry of Dental Institute RIMS, Ranchi, Jharkhand. He is also incharge of  Tobacco cessation clinic of Dental Institute RIMS, Ranchi,  Jharkhand. He is a renowned academician with a number of national and international publications to his credit. He has authored a number of books with publishers of national and international repute. He has completed his BDS from Vidyapeeth Pune  and MDS in subject of Public Health Dentistry from MCODS Manipal, Manipal University. He is regularly working to improve Oral health care needs of rural and deprived communities.

Dr. Syeda Shamima Nastaran Quazi, She finished BDS from Jaipur dental college, Rajasthan. She is currently working as dental surgeon in Dispur Hospital, Assam. She has national and international paper publications to her credit.

Salient Features:

Background

The rehabilitation of missing teeth by implants is one of the most demanding and complex treatments due to the necessity of obtaining an optimum esthetic result. At the level of the soft tissues, it involves obtaining the complete formation of the papilla and creating a harmonic contour of the gingival margin. Understandably, it is impossible to achieve satisfactory aesthetic results without peri-implant soft tissue that is harmonious with the adjacent tissues in color, form, and contour. Peri-implant architecture thus takes a major share in the aesthetic setup of any implant-supported restoration.

At the level of the papilla, there are two decisive factors that play an influential role: the formation of the biological width and the distance between the alveolar crest and the contact point. The position of the gingival margin depends mainly of the height and width of the facial bone, as well as on the biotype. The surgical technique, as well as certain prosthodontic aspects related to the implant, can influence the final position of the soft tissues.

In order to achieve long-term stable peri-implant health, it is important to achieve an adequate soft tissue seal around dental implant/restorations. The constant dimension of a biological width (of the soft tissue) often dictates where the final gingival margin will be. It is therefore not surprising that the position and stability of the alveolar bone ridge surrounding dental implants ultimately determines where the gingival margin rests. For dental implant restorations in the aesthetic zone, this is a crucial variable for the clinician to understand and deliver.

 The expected aesthetic outcomes of implant therapy may be enhanced by manipulating or augmenting peri-implant soft tissues using periodontal plastic surgery. In addition, several factors such as presence of pre-existing ridge deformities, quality and quantity of soft tissue over the ridge and surgical strategies in implant placement/ uncovering are considered to be related to the final aesthetic outcomes of implant therapy.

Aesthetic implant positioning has a direct influence on the soft tissue profile and final appearance. The more precisely the implant is positioned; the easier it will be to obtain a natural-looking, implant-supported restoration in its soft tissue housing. With optimal implant positioning, any gingival discrepancy will be avoided, thus minimizing the need for further corrective surgeries and soft tissue reconstruction.

Unlike the natural dentition, a dental implant is a metallic body inserted into the jawbone. Therefore, its collar does not receive any blood supply from a surrounding periodontal ligament or any other vessels. Rather, it acquires a fibrous connective tissue band around its collar that is more dense and acellular. In addition, the very fragile nature of the oral mucosa makes its ability to withstand excessive clinical manipulations unpredictable, which can lead sometimes to asymmetrical final implant prostheses.

In view of the above, clinicians are required to handle peri-implant soft tissues with exceptional care because of their reduced blood circulation and delicate nature. Mastering the techniques of manipulating the delicate peri-implant soft tissue architecture in the aesthetic zone is therefore considered mandatory. It can lead to a remarkable improvement in the aesthetic outcome of implant-supported restorations when the other treatment steps are properly fulfilled.

As implant survival and success rates are high, the esthetic outcome has become the main focus of interest in esthetically sensitive areas. To achieve an optimal esthetic outcome, implants must be placed in an optimal position and inclination. Ideally, successful implant-supported restorations should imitate the appearance of natural teeth. The condition of the peri-implant soft tissue appears to be the critical determinant. The implant-supported restoration should be in symmetry with the reference tooth. The level of the peri-implant soft tissue, which influences the crown length, and its color and texture are decisive for the ‘natural’ appearance of implant- supported tooth replacements.

At the level of the bone, implant felix/ body is secured at the surgical site in the bone by a process called as osseointegration. Healing of endosseous implants develops through the mechanism of osseointegration, in which bone grows right up to the implant, without any soft tissue, cartilage, or ligament fibers being present between the bone and the implant surface. At the molecular level, the bone-implant interface could be described as a zone of cells and proteins in close apposition to a polycrystalline surface of titanium. This structure results in a very strong connection between bone and implant, so that the 2 components cannot be separated without fracture. Because of this connection, implants exhibit no micromobility in the alveolar bone, which would affect their behavior when they are exposed to occlusal forces. An osseointegrated implant may move only 10 micrometer when loaded. This is primarily because of bone flexure. So, here it becomes very important for the prosthodontist to take into considerations, the available bone in terms of quality and quantity and various other factors when planning for implant placement. And it also becomes very important for us to have a thorough knowledge of bone physiology and understanding bone behavior during oral bone grafting, implant placement, osseointegration and long-term bone maintenance.

This Book brings in a comprehensive compilation of information regarding the significance of soft tissues in implantology, their defects and management.

Summary  

USP is “SOFT TISSUE CONSIDERATIONS IN OSSEOINTEGRATED SUPPORTED PROSTHESIS: SURGICAL AND PROSTHETIC ASPECT”

In this book, we have focused on the surgical and prosthetic aspects of soft tissues. Definitely this book is different in all aspects starting from contents, as this book gives detailed information about the prosthetic products which includes mainly:-

• In this book we have dealt with all the surgical procedure involved in the placement of Dental Implants.
• It mainly focuses on the soft tissue considerations involved in the placement of osseointegrated supported prosthesis.
• It mainly focuses on the Do’s and Dont’s  involved in the surgical placement of Dental Implants.
• This Book brings in a comprehensive compilation of information regarding the significance of soft tissues in implantology, their defects and management.