Esthetic Essentials

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  Posted by: Dental Design      9th January 2019

Regardless of the type of dental procedure provided to a patient, the complexity of the case or the clinical techniques used, success of treatment is determined by several factors. For dental implants, these include achievement of osseointegration and primary stability, minimal bone loss, longevity of the implant and prosthetic function.[1]

Esthetics has become key for all dental implant cases as well, as certain standards need to be met in order for implant surgery to be considered a complete success. In a society where appearances can affect every aspect of a person’s life, esthetic improvement is certainly important to implant patients – especially to women, as research shows.[2]In order for esthetics to be acceptable to patients, it’s crucial that their expectations are managed from the very beginning of the treatment process.


Managing expectations

There is absolutely nothing wrong with patients feeling excited about the potential improvements to their quality of life that can be enjoyed following implant therapy. However, it is necessary to manage their expectations so that they are realistic about what treatment will be like and how their smiles will be affected thereafter. Unfortunately, whether they are a little too enthusiastic about what treatment can achieve or simply have incorrect information, some patients’ expectations can rise above anything that is realistically achievable in practice – meaning they are unlikely to be satisfied with the outcome, esthetic or otherwise. This is supported by a study that found a significant portion of participants presented with inaccurate perceptions and unrealistic expectations, which the authors stated dental professionals would need to address prior to implant treatment.[3]

Another reason for effectively managing patient expectations is to protect the clinician(s) from dento-legal complications later down the line. Among the top reasons for legal disputes in dental practices in recent years has been a failure to manage patient expectations of both the treatment and service they will receive.[4],[5]

With more accurate information, a better understanding of the procedure and details on all the possible factors that could affect esthetics, patients are more likely to develop realistic expectations. These will be easier to meet for the dental team, resulting in greater patient satisfaction and a lower risk of complaints. It could involve providing patient information leaflets after the initial consultation, using the latest imaging technology to communicate the clinical procedure required or showing them the digital mock up after planning to suggest what they might actually look like after surgery. However you do it, it’s important that your patients appreciate what is and what is not possible so that they are not disappointed by the final outcome.


Improving esthetics

While there is always a limit on what can be achieved, some of the esthetics delivered by implantologists and restorative dentists today are outstanding. This is often the result of practitioner skill, as well as communication between the professional team and patient. Diligent planning of both the surgical and prosthetic stages should be a priority – there must be a balance between the ideal implant position and angle, and the prosthesis to be fitted, if the very best outcome is to be achieved. Many clinicians today ‘plan with the end in mind’ for this reason.

The esthetic outcome of implant treatment depends on various factors such as smile line height, implant type, root position of the adjacent teeth, bone and gingival volume, as well as height and thickness of the bone wall.[6]All these need to be considered during the initial planning phase of treatment so that potential complications can be minimized and treatment made more predictable.

For example, using an implant with the wrong body or shoulder dimensions could cause exposure of the metal collar and affect the esthetic result. The visible metal rim would not only be ugly, but it would also draw attention to the fact that the implant-restoration is not a natural tooth – something that patients are unlikely to accept. Where this may be a potential issue, planning to use an all-ceramic implant like the new NobelPearl™ would facilitate delivery of a highly esthetic outcome, maximizing patient and practitioner satisfaction.

It is also important to manage the soft tissue around the dental implant before, during and after surgery for the very best results. Thin gingival biotypes have been associated with greater recession after surgery while thick biotypes are more stable – to maintain a natural appearance once the implant is placed and increase the amount of keratinized tissue, grafting procedures may be considered.[7]


Essential for success

It can be argued that the esthetic outcome of dental implant treatment is just as important as other factors of treatment success such as primary stability, longevity and function. Make sure you’re maximizing the opportunity for natural looking implant-retained restorations while managing your patient expectations for the best results.



For more information, contact Nobel Biocare on 0208 756 3300, or visit

[1]Karthik K, Sivakumar, Sivaraj, Thangaswamy V. Evaluation of implant success: A review of past and present concepts. Journal of Pharmacy & Bioallied Sciences. 2013;5(Suppl 1):S117-S119. doi:10.4103/0975-7406.113310.
[2]Rustemeyer J, Bremerich A. Patients’ knowledge and expectations regarding dental implants: assessment by questionnaire. Int J Oral Maxillofac Surg. 2007;36:814–817. doi: 10.1016/j.ijom.2007.05.003.
[3]Yao J, Li M, Tang H, Wang PL, Zhao YX, McGrath C, Mattheos N. What do patients expect from treatment with dental implants? Perceptions, expectations and misconceptions: a multicenter study. Clinical Oral Implants Research. March 2016. (28)3; 261-271
[4]Beynon K. Litigation and complaints in the dental practice. BDJ Team. August 2014 (1)
[5]Dental Defence Union. Most complaints arise from failure to meet patient expectations, says DDU. Press Centre. Press releases. October 2013.[Accessed August 2018]
[6]Balasubramaniam AS, Raja SV, Thomas LJ. Peri-implant esthetics assessment and management. Dental Research Journal. 2013;10(1):7-14. doi:10.4103/1735-3327.111757.
[7]George JP, Dhir S. Soft tissue and esthetic considerations around implants. J Int Clin Dent Res Organ [serial online] 2015 [cited 2018 Aug 16];7, Suppl S1:119-31. 


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