I think replacing a single maxillary central incisor is quite challenging.
In positioning the dental implant fixture I try to orient so that the center
of the
long axis passes through a point about 2mm lingual to where the incisal
edge
of the natural tooth should have been. I position the fixture about
2mm
lingual to the adjacent central and lateral. I am using Atlantis
abutments
and cement retained crowns. What are others doing differently or
better?
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There are different opinions about that. You could place the implant that the center of the long axis passes through a point where the incisal edge is (usually an angle abutment and cemented restoration) or the cingulum(usually a screw retained restoration. Lingually positioned implant is more forgiving that labially one.You also have to worry about the incisal-apically position which usually position the head of the implant about 2,5-3mm below the gingival crest .
Everything said above is valid, but when there is bone loss the treatment becomes even more challenging, specially if you are only replacing one tooth.Ii is very imprtant to have a surgical stent at the time of placement so that we don’t loose orientation. If after doing the bone sounding there are doubts, then another diagnostic procedure should be implemented. The upper anterior area is very challening to work at, but if the treatment is planned accordingly the results will be very rewarding.
Agree that placing more palatally/lingually, and deeper has advantages …. “longer “run for the emergence profile, ability to “squeeze the interproximal tissues” for better papilla fill, and reduce the effect of a more labially placed implant to cause “recession” and show the implant abutment, or collar.
BL(bottom line):Have always better esthetic results by placing incisor implant more patatal/lingual, and deeper (i.e. 4mm below Free Gingival Margin(FGM).
The use of the surgical stent is a great idea because you can check buccal lingual and mesial distal position as well as depth of placement. Be aware if you place the head OF the implant deeper than 4mm from the free gingival margin and the bone level moves to the first thread then you can end up with probing depth of 5mm or more which is difficult to maintain and eventually you will have anaerobic bacteria growth. The probing depth will even be more on the interproximal.
There is a lot of literature that proves if the pocket is 5mm or more you increase the anerobic bacteria. I don’t know if it makes any difference in the long term survival.
Salama, Salama and Garber have a great article on anterior implant placement. THe ruls are not hard and fast you really must adjust for the tissue type. Different tissue types (i.e. thick vs thin) have different characteristics. I prefer to do custom milled zirconia abutments. For a temporary abutment I use the nobel immediate temporary abutment. THey are essentially small hexagonal posts that screw into the top of the implant. You then build your acrylic/composite crown to the exact form you need to fill your tissues out. I like this because it can be adjusted. I am not a big fan of the atlantis system. Also the above are suitable for immediate placment
I have existing implants and extensive bone loss where I need new implants. Can you tell me the procedures for harvesting my own bone to use in my jaws.