The range of indications in implant dentistry has broadened in the past decades from fully edentulous to partially edentulous jaws. Replacing missing teeth with dental implants has become a frequent and important indication in current dentistry. In the early days of implant dentistry, the treatment aim was to insert a titanium implant that, if all went well, would osseointegrate and could or could not be restored with something that looked reasonably close to a natural tooth. The pre-surgical planning consisted more or less only of evaluating whether there was enough bone volume to support an implant of a certain length and diameter. The outcome of implant therapy has been presented in the majority of clinical studies by focusing only on implant survival without providing detailed information on the reconstructions and their aesthetic outcome. A recent systematic review concluded that 8.7% of inserted implant supported single crowns had unacceptable or semi-optimal aesthetic appearance.
Today, the treatment goal has changed and now it is to mimic the natural tooth to give aesthetically pleasing restorations that should be stable and function for a long period of time. Hence the pre-surgical planning has moved away from only evaluating bone volume to planning the prosthetic restorations in detail prior to surgery and understanding the biological changes in the soft and hard tissues.
In the present lecture, the seven steps of pre-surgical planning will be discussed in detail. Every step will be evaluated and risk factors that could influence the treatment outcome discussed. Tips and tricks on how to avoid aesthetic failures to achieve predictable outcomes will be discussed. Important factors such as the tooth position, number of implants needed, prosthetic platform, type of retention, three-dimensional implant position, time of implant placement, and the need for ridge preservation or bone augmentation, will be addressed.