A decision-making tree for evaluating an esthetically compromised single dental implant

• Published in: Journal of esthetic and restorative dentistry 2023-12, Vol.35 (8), p.1239-1248
• Main Authors: Alrmali, Abdusalam, Stuhr, Sandra, Saleh, Muhammad H A, Latimer, Jessica, Kan, Joseph, Tarnow, Dennis P, Wang, Hom-Lay
• Format: Article
• Language: English
• Subjects: Connective Tissue - transplantation; Decision making; Dehiscence; Dental Implantation, Endosseous - methods; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Interdisciplinary aspects; Prostheses
• ISSN: 1496-4155; 1708-8240; 1708-8240
• DOI: 10.1111/jerd.13100

To develop a comprehensive decision-making tree for evaluating mid-facial peri-implant soft tissue dehiscence in the esthetic zone and provide a systematic approach for assessing various clinical case scenarios, determining appropriate treatment strategies, and considering factors such as the need for soft tissue augmentation, prosthetic changes, or implant removal. This clinical decision tree illustrates numerous case scenarios with various esthetic complications around an esthetically compromised, but clinically healthy single implant and provides clinicians with possible solutions as a predictable map for horizontal and vertical soft tissue augmentation in order to manage different clinical circumstances. According to current evidence, the key to treating such esthetic complications is the use of an adequate pre-surgical prosthetic interdisciplinary approach with proper surgical techniques in order to optimize soft tissue dimensions and create better esthetic results. This may be accomplished through a purely surgical, combination of surgical and prosthetic, or purely prosthetic approaches. The present report describes a series of successfully treated peri-implant esthetic complication cases in accordance with the decision-making tree that the authors recommend in order to achieve better long-term esthetic outcomes. The combination of adequate pre-surgical prosthetic interdisciplinary collaboration and proper surgical technique is critical in the optimization of sufficient soft tissue dimensions and contributes to a more highly esthetic result. This study demonstrates a clinical decision-making tree to provide comprehensive, effective therapy of an esthetically compromised dental implant by using one of the following approaches: purely prosthetic, purely surgical, or a combination of surgical and prosthetic with or without abutment removal.