Dental Implants in the Maxillary Anterior Zone

“The freestanding implant will be able to withstand the forces exerted in canine guidance. I have seen many successful cases restored like this.” Michael Sonick, DMD

An Interview with Michael Sonick, D.M.D.- Discussing Dental Implants in the Maxillary Anterior Zone

Osseonews (ON): Dr. Sonick what are some of the challenges you and your referring dentists have overcome in the maxillary anterior aesthetic zone?

Dr. Sonick: In general a regular platform 4mm diameter implant can be used to replace a maxillary incisor and the adjacent tooth. For example if the patient is missing a lateral incisor and a canine, we can place a regular platform implant in the canine area and cantilever off the lateral incisor pontic.

ON: How do you manage canine guidance in a situation like that?

Dr. Sonick: You can build in a progressive anterior disclussion that shifts guidance to the premolars. This reduces oblique forces on the canine and its cantilever.

ON: How would you manage the replacement of a missing maxillary canine while still maintaining canine guidance?

Dr. Sonick: You can accomplish this by placing a wide platform 5mm implant at least 11mm long. The freestanding implant will be able to withstand the forces exerted in canine guidance. I have seen many successful cases restored like this. If there is only enough bone volume for a regular platform 4mm implant it will still have a very good chance of long-term survival. However I would recommend a wide platform implant if at all possible.

ON: What treatment plan would you recommend for replacing the maxillary incisors?

Dr. Sonick: Well first off I need to emphasize that there is rarely adequate bone to place wide platform implants in this area. There is too much chance of gingival recession. The most predictable plan for long-term success is to use regular platform implants in this area. That being said I would recommend two regular platform implants placed in the maxillary lateral incisor areas and restored with a four unit fixed partial denture. If that is not possible than I would recommend placing two regular platform implants in the central incisor areas and restoring with a fixed partial denture with cantilevered pontics for the lateral incisors.

ON: How about replacing maxillary canine to canine?

Dr. Sonick: The best way to restore this situation is to place regular platform implants in the canine and central incisor areas. You should then fabricate two three-unit fixed partial dentures, one running from canine to central incisor and then central incisor to canine. Fitting two three-unit fixed partial dentures is much easier than fitting a six-unit fixed partial denture.

ON: What about replacing each of the missing teeth with a single, freestanding implant retained crown?

Dr. Sonick: Well if you have adequate space, you may be able to do this. But one problem that is difficult to overcome would be placing the implants too close together. You need at least 3mm between adjacent implants. However, even with 3 mm of bone between adjacent implants, you will still have a problem maintaining the papillae in the proper position. In general, you will see a millimeter less of a papilla between the contact point and bone between two adjacent implants as you will between adjacent natural teeth or between a natural tooth and an implant. The one place where you can cheat a little is when you are replacing two maxillary central incisors. There are two reasons for this. One, the central incisors are symmetrical and slight changes in the papilla will not be as obvious. Two, the nasopalantine papilla on the palate gives you an added bulk of tissue which gives you a pseudo-papilla and gives the appearance of a fully reformed papilla in many cases.

Dr. Michael Sonick is a full time practicing
periodontist and implant surgeon in Fairfield, Connecticut. He is also
an active teacher, clinical researcher and author. He is a diplomate of
the American Board of Periodontology and on the Editorial Board of
Contemporary Esthetics and Restorative Practice. He currently is a
Guest Lecturer at New York University School of Dentistry in their
international dental program and was previously a Clinical Assistant
Professor in the Department of Surgery at Yale University School of
Medicine.