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USERREPORT
by Drs Birgit Grubeanu-Block & Daniel Grubeanu
Long-term Esthetic
Stability Through
Structure Retention
Patients interested in implant therapy are particularly interested in an
esthetic, friendly and simply brilliant smile. Advanced dental technology is
being used to make the visible white components of the dental prosthesis
more demanding esthetically. However, a really natural appearance can
only be achieved in combination with an emergence profile that is
indistinguishable from the neighboring teeth. An essential condition for acceptable
peri-implant soft-tissue esthetics is therefore the retention of the structures around
the implant. But exactly how can bone and soft tissue remain stable over the long
term? And above all what factors must be taken into account for this?
Figure 1 Pre-operative situation
Biological Width, Dentogingival Complex
of Teeth and Implants
The term “biological width” describes the dimension of certain periodontal and
peri-implant soft-tissue structures, the gingival sulcus, marginal epithelium and
supracrestal connective tissue. Because marginal epithelium and supracrestal
connective tissue can adhere to teeth and implants, this is referred to as epithelial
and connective-tissue attachment. The basic principle of the biological width is
that bone projecting into the oral cavity is always covered by periosteum,
connective tissue and epithelium (Tarnow et al. 2000). The epithelial and
connective-tissue attachment in this case has a specific thickness (dimension).
Animal studies have demonstrated that the thickness of the peri-implant soft
tissues remains relatively constant at 3 mm (Buser et al. 1992; Berglundh et al.
1996; Cochan et al. 1997; Hermann et al. 2000; Todescan et al. 2002).
Peri-implant Bone Resorption
Possible causes for peri-implant bone resorption are among the following:
1. Surgical trauma during placement of implant and abutment (Brånemark et al.
1969; Adell et al. 1986; Cochran et al. 1997)
Figure 2 Mucosa conditions
2. Positioning of the implant relative to the alveolar ridge with supracrestal,
Figure 3 View of the alveolar arch of maxilla Figure 4 Subcrestal placement of the Ankylos implant Figure 5 Facial bone deficit
Dental Asia • May / June 2008
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