The Pursuit of Cleansable and Stable Implant Esthetics

<p>In the case of implant treatment in the esthetic zone, not only white esthetics but also pink esthetics will be required for optimal esthetic results. In addition, a good relationship of the superstructure and gingiva with the face and lips is indispensable for achieving esthetically pleasing treatment outcomes. Therefore, the criteria for esthetics of anterior implants set a higher standard than for posterior implants. We should observe the following rules in order to achieve successful implant esthetics. 1) Bone thickness of 2 mm or more is necessary to maintain homeostasis of bone around an implant and to support stable labial gingiva. 2) As some degree of crestal bone resorption around implants will occur due to saucerization after abutment connection, the distance between implants should be more than 3 mm and the distance between implant and natural teeth should be more than 1.5 mm in order to preserve sufficient inter-proximal bone to support the interdental papilla between them. 3) Implants should be placed in the optimal position, depth and direction to achieve both esthetics and cleansability. 4) As the defense mechanism of peri-implant soft tissue is considered more fragile than that of natural teeth, adequate keratinized mucosa around implants is needed. Hard and soft tissue augmentation is required for optimal reconstruction of bone and gingival architecture in patients with a severe alveolar deformity. A predictable and effective GBR procedure is considered and clinical ingenuities for preserving keratinized mucosa are discussed.</p>