Introduction
social attributes that are vital to one’s self-image, social interaction, and physical attractiveness. This consideration has led to the understanding of the importance and the value of esthetic oral rehabilitation.
Esthetic Implant Therapy Carlsson and others (1967) found that esthetics is a determining factor for complete denture success. Both the patient’s and observer’s concept of the esthetic result have been found to be highly significant (Waliszewski 2005). Several authors have found further evidence that esthetics is the predominant factor in complete denture success (Vallittu et al. 1996, Brewer 1970, Hirsch et al. 1972). Liefer and others (1962) reported they had statistically fewer adjustment appointments and a greater number of satisfied patients when all esthetic decisions were made by the patient. This implies that when the esthetic result was successful, the dentures were more successful overall, a finding echoed by Vig (1961). A survey by Vallittu and others (1996) found that patients wearing removable dentures considered the appearance to be the most important asset of the teeth. Brewer (1970) demonstrated through a limited clinical trial that denture patients almost exclusively chose the more esthetic denture over the more comfortable or functional denture. Despite the fact that solutions to functional and comfort-related problems are available, successfully restoring the appearance of an edentulous patient remains problematic. Early literature projected the importance of esthetics. White (1872) introduced what is probably the most original esthetic concept when he described his theory of correspondence and harmony. He highlighted the relationship among age, gender, and appearance; the proper tooth-to-face size proportion; and color harmony between face and teeth (White 1884). Esthetic implant therapy is an advanced treatment modality in today’s field of implantology, aiming to achieve an ideal esthetic and functional treatment outcome within the alveolar ridge or the edentulous spaces. Esthetic implant therapy has become an integral part of modern implant dentistry, because it complements the overall results of oral implantology. Significant advances have been introduced recently, including novel techniques to develop or regenerate implant recipient sites by stimulating both hard and soft tissues and to reproduce healthy peri-implant tissue contours that resist mechanical forces and masticatory trauma. Despite the advances and the success seen in many clinicians’ practices, there is insufficient scientific support regarding the overall success and longevity of esthetic implant therapeutical techniques in well-controlled,
7
long-term studies. The advances in esthetic implant therapy and soft tissue and hard tissue regeneration are more the author’s observations than standard protocols that are used in clinicians’ daily practices. Therefore, a standard surgical and prosthetic protocol for esthetic implant therapy is mandatory. Esthetic implant therapy demands evidence-based publications, and fewer case reports, to establish a standard of care for every clinician. All efforts should be made to standardize methodologies for every clinical situation, and then test those procedures against evidence-based protocols. Past advances resulted from patients’ unwillingness to accept dental restoration with metallic margins or unmatched. These challenges, some of which have been extremely difficult to address, have benefited from original plastic periodontal surgical techniques that are now used routinely to correct various soft tissue defects such as gingival recession, mucogingival defects, and imbalanced gingival contours. While these traditional periodontal plastic surgery techniques for natural teeth have been helpful, their usefulness for dental implants is limited in terms of timing and predictability. As a result of these continuous adaptations, new classifications of hard and soft tissue defects have been developed to describe each patient’s clinical situation and improve communication among the dental team. “Reconstructive esthetic implant therapy” has been suggested as a term to describe the different intraoral procedures and their clinical implications. This classification should be continually updated by setting a standard protocol for detailing certain procedures, defining new terms, and confirming the evidence behind clinical concepts. This in turn will help esthetic implantology emerge as a distinct specialty of implantology, which will continue to develop and expand, along with functional implantology (Kazor et al. 2004). Over the past 35 years dental implantology has proven to be a predictable method for restoring function in the oral cavity (Adell et al. 1981, Engquist et al. 1988, Schnitman et al. 1988). The late 1980s and early 1990s witnessed the expansion of dental implants to include treatment of partially edentulous patients with fixed, implant-supported restorations. These new clinical applications include the treatment of missing anterior single dentition, which has a documented success rate in excess of 90% (Schmitt and Zarb 1993, Engquist et al. 1995, Anderson et al. 1995, Ekfeldt et al. 1994). As awareness of this treatment has increased, restoration of missing maxillary anterior single teeth with implantsupported restorations is quickly becoming the preferred treatment modality, despite the fact that it remains one of the most esthetically difficult and challenging of all implant restorations.