One way to optimise implant aesthetics


  Posted by: Dental Design      26th May 2023

Aesthetics are a priority for most patients seeking any kind of dental treatment. When it comes to more invasive procedures that require greater investment from the patient themselves, aesthetic expectations are often at their highest. As such, clinicians offering dental implant therapy must do everything in their power to encourage the best possible outcomes for their patients. This includes minimising the risk of infection in order to optimise the health and appearance of the soft tissue around the surgical site.

“We are drowning in information but starved for knowledge” – John Naisbitt

Across all areas of dentistry, patient expectations have grown in recent decades. This may be for a number of reasons. The general population has easier access to information than it ever has thanks to the internet. Patients need only search for 10 minutes to find a wealth of details about the various dental procedures available today. The same search will also produce no end of images that demonstrate the stunning smiles of people who have undergone procedures and achieved amazing results. Social media is particularly good for this, with thousands of accounts showcasing some truly inspiring aesthetic results following dental treatment.

The problem is that patients do not understand the many variables that contribute to such a result, and mistakenly believe that they too will get the same outcomes. They do not appreciate that their anatomy or their budget might not allow for the same aesthetic results as they see on someone else. Similarly, they might not realise that the photos they see took many months or years to achieve, including several different procedures. 

With regards to dental implants specifically – though the evidence remains weak and more research is needed – a systematic review[i] found that many patients had unrealistic expectations of what implant treatment could achieve, which could lead to dissatisfaction with the final results. This can have far-reaching consequences. Not only can this impact the patient-practitioner relationship and their future dental care, but this could also have negative repercussions for the practice and its reputation too. It is therefore very important for clinicians to manage patient expectations from the very beginning of the treatment process, especially in relation to aesthetics.

Soft and hard tissue considerations

There are several factors that can influence the aesthetic results of dental implant treatment, including soft tissue related complications. Some of the most common soft tissue concerns affecting aesthetics according to Wang et al[ii] are asymmetry of the peri-implant mucosa level, lack of papilla, unnatural gingival colour and volume deficiency/concavity.

Peri-implant disease is another issue that can impact the soft tissue post implant placement. Researchers have estimated that 30% of implants placed experience peri-implant mucositis, while 10% suffer from peri-implantitis.[iii] This can lead to gingival recession (and bone resorption), which both affect smile aesthetics. Of course, some soft tissue recession is expected with any implant placement – Small and Tarnow[iv] estimated the average to be around 0.75mm in the first three months, with a total of 1mm within the first year. In cases where patients were at greater risk of recession, some studies[v] recommend regenerative or augmentation techniques to minimise the impact and enhance the final aesthetic outcome.

Regarding the hard tissues, the volume of the underlying bone directly correlates with the volume, and therefore aesthetics, of the soft tissue. Tarnow et al[vi] showed this by linking the crestal bone height to the dental papilla. 

Optimising aesthetic outcomes

With so many aspects to consider when looking to minimise the risk of aesthetic complications during implant treatment, meticulous assessment and planning are crucial. So too is post-operative care and the on-going oral hygiene. One systematic review and meta-analysis[vii] demonstrated clear benefits of supportive peri-implant therapy to reduce rates of peri-implant disease and resulting marginal bone loss.

It is essential to educate the patient so that they understand the role they themselves play in implementing consistent oral hygiene routines and minimising the risk of post-operative infection. They also need access to high-quality products – like Clinisept+ Dental Mouthwash. Clinisept+ is a next generation hypochlorous solution that is clinically proven to deliver superior antimicrobial protection. It minimises the risk of infection before and after oral surgery without causing staining or any of the other negative side effects associated with products containing chlorhexidine. However, because Clinisept+ is also non-toxic, non-irritant, anti-inflammatory and hypoallergenic, it provides the optimum environment for tissues to recover. Dentists and patients report excellent post-surgical outcomes.

Aesthetics remain an important consideration for patients seeking implant therapy, alongside function and longevity. To optimise treatment results, clinicians and patients must work together. Only with carefully planned treatment, the right surgical techniques and meticulous oral hygiene maintenance can outcomes be truly optimised. 

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[i] Yao J, Tang H, Gao XL, McGrath C, Mattheos N. Patients’ expectations to dental implant: a systematic review of the literature. Health Qual Life Outcomes. 2014 Oct 29;12:153. doi: 10.1186/s12955-014-0153-9. PMID: 25358599; PMCID: PMC4221691.

[ii] Wang IC, Barootchi S, Tavelli L, Wang HL. The peri-implant phentotype and implant esthetic complications. Contemporary overview. J Esthet Restor Dent. 2021; 33:212-223

[iii] Lee CT, Huang YW, Zhu L, Weltman R. Prevalences of periimplantitis and peri-implant mucositis: systematic review and metaanalysis. J Dent. 2017;62:1-12.

[iv] Small PN, Tarnow DP. Gingival Recession Around Implants: A 1-Year Longitudinal Prospective Study. Int J Oral Maxillofac Implants. 2000; 15:527-532

[v] Wada M, Mameno T, Otsuki M, Kani M, Tsujioka Y, Ikebe K. Prevalence and risk indicators for peri-implant diseases: A literature review. Jpn Dent Sci Rev. 2021 Nov;57:78-84. doi: 10.1016/j.jdsr.2021.05.002. Epub 2021 Jun 8. PMID: 34158874; PMCID: PMC8203834.

[vi] Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995–6.

[vii] Atieh MA, AlAli F, Alsabeeha NHM. Outcome of supportive peri-implant therapy on the rates of peri-implant diseases and marginal bone loss: a systematic review and meta-analysis. Quintessence Int. 2021;52(2):122-131. doi: 10.3290/j.qi.a45428. PMID: 33433078.


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