Implant therapy poses additional challenges when delivered in the anterior segments of the dentition. In these areas, treatment results need to fulfill not only functional and biologic requirements but also esthetic demands. The 21st-century dental patient has become more enlightened in terms of dental esthetics, and the contemporary practitioner needs to be prepared to address their often heightened expectations. Proper placement of implant fixtures in the esthetic zone is dependent on the presence of adequate bone volume following tooth extraction. Substantial loss of the horizontal and vertical dimensions of the alveolar ridge can occur after tooth extraction, and clinical trials have shown the benefit of performing procedures aimed at preserving the dimensions of the extraction socket in conjunction with tooth removal, namely bone grafting, guided bone regeneration, and the use of biologic agents. This presentation will review the existing literature on procedures that maximize esthetic results with implant-supported restorations in the anterior segment. It will also discuss the surgical steps involved in treating the extraction socket with bone grafts, guided tissue regeneration, and other agents and will attempt to correlate clinical decisions with the existing scientific evidence in the field. Topics to be examined include the need to elevate a buccal flap, the selection of a bone graft, the use of resorbable and nonresorbable membranes, and the healing period until implant placement.
Paulo M. Camargo, DDS, MS, MBA, received his dental degree from the University of Parana, Brazil, in 1984 and his certificate in periodontics from University of California Los Angeles (UCLA) in 1990, where he directed the predoctoral program for 15 years and currently serves as a professor of periodontics, the associate dean of Clinical Dental Sciences, and the chairman of the Curriculum Committee and the periodontics track of the revised curriculum. He is a past president of the Western Society of Periodontology and a Diplomate of the American Board of Periodontology and has published over 70 scientific papers. He maintains a private practice in the UCLA Periodontics and Implant Group Practice.
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