Establishing Proper Communication with the Implant Surgeon and Determining Ideal Implant Position

During implant planning, communication among all members of the implant treatment team is required to ensure ideal implant surgical position. Once the implant is placed, its position cannot be altered! The restorative dentist and the implant surgeon can collaboratively decide on the ideal implant angulation and bodily position based on the prosthetic position and the type of the implant restoration desired.³¹ In addition, the surgeon should be specifically informed regarding the desired cervico-enamel junction (CEJ) level and the timing of provisional restoration placement. A 3D surgical guide that is based upon careful implant planning and is stable intersurgically should be provided to the surgeon for the implant placement procedure.³¹

Ideal implant body position

The correct three-dimensional implant position (interproximal, bucco-lingual, inciso-apical, and axial inclination) is a fundamental factor in providing a natural-looking final restoration.^4,7 Mesio-distally, the implant should be centered in the missing tooth space with at least 1.5mm space between the implant platform and adjacent tooth CEJ to provide optimal tissue contours and appropriately distribute the forces.³² It has been reported that maintaining the minimum 1.5mm distance ensures that the potential vertical defect associated with the implant (smooth collared implants) will not affect the bone of the adjacent natural tooth and thus help in maintaining the interdental papilla.³³ Faciopalatally, the implant should be positioned 2mm from the buccal plate at the crest and 1.5mm or more from the palatal bone.^34,35 Implants planned in the anterior region of the jaw should have a cingulum/incisal sagittal angulation. Posterior implants should be positioned such that their long axes are perpendicular to the occlusal plane.^36,37 Incisoapically, implants planned in the anterior and the posterior regions of the jaw should be placed 3-4mm and 2-3mm respectively below the ideal prospective zenith of the planned restoration.⁴ Implant placement that is too apical may predispose the implant to peri-implantitis and adversely affect the bone levels around the implant. Shallow implant placement (with a standard-diameter implant) leads to insufficient crown-height restorative space, and consequesntly the development of an abrupt flare in the emergence of the restoration (Figure 8).^4,38 Osteoplasty may be performed in such situations to permit implant placement at the ideal restorative depth. This will allow the development of a gradual flare in the emergence of the restoration.

Figure 8. Suboptimal emergence profile associated with shallow and off-centered implant placement and/or improper implant diameter.

Figure 8. Suboptimal emergence profile associated with shallow and off-centered implant placement and/or improper implant diameter.