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Fundamentals of Esthetic Implant Dentistry
A Figure 12.6A. Missing inter-implant papilla due to improper mesio-distal implant positioning.
B
C
Figure 12.6. B. An implant is placed in the inter-dental space. C. The implant was removed.
A
Figure 12.8. An implant is placed too far labillay that is impossible to restore.
B
Figure 12.7. A. Implants are misplaced leaving no embrasure space. B. The use of angulated abutments was not able to solve the misplacement.
Fair numbers of clinical approaches have been described for resolving misaligned and malpositioned dental implants. If unfavorable inclination of the implant ďŹ xture is the only problem, angulated abutments can often improve the prosthetic results of an implant-supported restoration. Using the preangulated
Figure 12.9. Improper violation of the labial plate via improper implant angulation.
abutments in cases in which the implant has been placed too far labially is not effective in most clinical situations because the preangled abutment usually requires a larger restorative dimension than other types. In addition, the gingival collar of the preangled abutment might encroach upon the peri-implant soft tissue and violate its natural contours. Interestingly, Nishimura and others (1999) have described an alternative approach for patients with misplaced dental implants that are difďŹ cult to restore with the regular commercially available abutments. This approach suggests using a custom-fabricated abutment that is specially designed to meet the esthetic and functional needs of each particular patient; however, this approach does not solve many misplaced implant cases. Other attempts have been made to correct implant misplacement by performing an osteotomy around the osseous housing of the implant ďŹ xture, moving the