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  5. Replacement of Anterior/Posterior Teeth

Replacement of Anterior/Posterior Teeth With Implants

Posterior

For optimal aesthetics of the implant crown and surrounding soft tissues in the anterior region, the implant shoulder should be positioned 1–2 mm apically to the labial CEJ of adjacent teeth, aligning with the ideal bone level. It is also important to ensure that there is at least a 1 mm bone plate on the buccal side of the implant. If a ridge defect is present, augmentation procedures may be necessary.

The emergence profile from the implant shoulder to the gingival margin should be flat and should closely resemble that of the corresponding tooth on the opposite side.

A slightly palatal incision is recommended to preserve as much keratinised tissue as possible on the labial side of the implant, which will enhance the aesthetic outcome. In the aesthetic zone, the papillae of neighbouring teeth should generally be excluded from the flap unless space is extremely limited for placing a single tooth implant.

 

Interior

When replacing up to four teeth posterior to the canines, a three- or four-unit fixed bridge supported by two implants can be used effectively. However, for replacing more than four posterior teeth on one side, it is recommended to use three implants to prevent overloading the abutments (Jemt and Lekholm, 1993).

In the posterior region, wider dental implants are preferred due to their higher survival rates (Lee et al., 2016). A minimum inter-implant distance of 3 mm is required for premolars and 4 mm for molars. The minimum mesiodistal space for a premolar implant is 7 mm, and for a molar implant, it is 8 mm. Implants should be placed at least 1.5 mm away from adjacent teeth.

To facilitate better plaque control, it is advisable not to splint adjacent implants together. Additionally, it is recommended to avoid splinting implants to natural teeth to prevent potential long-term biomechanical and biological complications (Pjetursson and Lang, 2008).

 

We would like to acknowledge Dr. Manraj Kalsi for his insights and contributions to this page