2019 Volume 32 Issue 4 Pages 285-294
Recently the criteria for success include esthetic satisfaction for patients and practitioners but it is not easy to achieve optimal esthetics in the esthetic zone in cases with multiple implants. This article discusses the conditions for long-term esthetic success. Among such conditions, the first step is setting realistic goals which are shared by both patient and practitioner. If the patient has a high smile, surgical reconstruction of the esthetic soft tissue framework will be necessary and the practitioner should understand the necessary procedures for hard and soft tissue management indicated by the pre established surgical template. If the patient's smile is low, the soft tissue architecture can be achieved prosthetically. Additionally, it is reported that 90 percent of low-smile patients still show the tip of the papilla, and an esthetic papilla tip plays a very important role in achieving a natural-looking smile.
Considering tissue management, partial extraction therapy is an effective tissue preservation procedure. When the tissue is lost, guided bone regeneration can augment the alveolar bone to satisfy the three-dimensional requirements for esthetics. Soft tissue management will inevitably be necessary to maintain regenerated bone and to acquire enough soft tissue volume and quality to be esthetically remodeled with a prosthesis. In addition, soft tissue management can be used to solve the potential problems which can occur in the maintenance period. For long-term esthetic success, practitioners must execute every treatment procedure as precisely as possible and establish a meticulous maintenance program.
