Reconstructive Aesthetic Implant Surgery

156 Pages·2003·22.47 MB·English

by  Abd El Salam El Askary

RECONSTRUCTIVE
AESTHETIC
IMPLANT
SURGERY
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RECONSTRUCTIVE
AESTHETIC
IMPLANT
SURGERY
Abd El Salam El Askary
Blackwell
Munksgaard
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El Askary, Abd El Salam
Blackwell Publishing Asia Pty Ltd, Reconstructive aesthetic implant surgery / Abd El Salam
550 Swanston Street, Carlton South, El Askary
Victoria 3053, Australia p. ; cm.
Tel: [phone] Includes bibliographical references and index.
ISBN 0-8138-2108-8
Blackwell Verlag 1. Dental implants. 2. Dental implants—Aesthetic implants.
Kurfurstendamm 57, 10707 Berlin, Germany [DNLM: 1. Dental Implantation—methods. 2. Reconstruc-
Tel: [phone] tive Surgical Procedures—methods. WU 640 E37r 2003]
I. Title
Europe and Asia RK667.I45E4 2003
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Contents
FOREWORD, vii
PREFACE, ix
ACKNOWLEDGMENTS, xi
1 Introduction, 3
Abd El Salam El Askary
2 Presurgical Considerations, 8
Abd El Salam El Askary
3 Aesthetic Implant Placement, 45
Abd El Salam El Askary
4 Soft Tissue Management, 60
Abd El Salam El Askary
5 Aesthetic Bone Grafting, 115
Luc Huys and Abd El Salam El Askary
INDEX, 139
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Foreword
The Kubler Ross emotional progression of anger, Today, in order to achieve the aesthetic results that our
denial, despair, bargaining, and finally acceptance when patients rightfully demand, many foundational cosmetic
facing serious illnesses or even death applies also to sig- procedures are now recognized as being necessary. Dr. El
nificant loss of teeth and related oral-facial structures. Askary's text traces the history of, describes, and illus-
The advances that have been made in implant dentistry trates the hard and soft tissue manipulations for optimal
allow us to interrupt this downward spiral for many results with implant-supported prostheses.
patients and virtually reconstruct their hard and soft tis- Personally, we both feel that in the arena of "cosmetic
sue deficits. dentistry" there is too much emphasis placed on signature
Originally, implants were devised to restore function, cases, tooth preparation, cementation and finishing of
and aesthetics was secondary. Soldiers suffering from the veneers, metal-free bridges, etc. and not enough emphasis
ravages of World War II and later conflicts cried out for placed on our ability to create the necessary bone support
effective therapies. Dental implants, devised by multiple and gingival architectures that are the sine qua non for
clinicians and investigators from around the world, often aesthetic case outcomes.
provided the foundation for functional prostheses. Dr. El Askary has confronted these scientific and prac-
As the field matured, many cases required a multidisci- tical clinical training problems head on. He has given the
plinary approach with identification of complex etiologic profession a treatise on how we should proceed when
factors. This central issue was often ignored or not appre- approaching simple as well as definitively complex cases.
ciated. Challenges were met with compromise. End goals His work is to be admired in the original meaning of the
were not clear. No one or everyone wanted to be the word, i.e., "wondered at." He is to be congratulated.
"captain of the ship." An educational revolution with Our patients need no longer sink to despair.
significant cross-training was the result. The upheaval of With our best personal and professional regards, we
commitment to excellence is still raging full force. remain
Sincerely,
Carl E. Misch, DDS, MDS, FACD, FICD
Co-Chairman, ICOI
Beverly Hills, Michigan, USA
Kenneth WM. Judy, DDS, FACD, FICD
Co-Chairman, ICOI
New York, New York, USA
VII
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Preface
In the name of God, the Beneficent, the Merciful. with a step-by-step clinical manual to aid practitioners in
achieving optimum clinical results.
The fashioning of modern dental implantology in the The first chapter of this book highlights the importance
hands of pioneers like Branemark, Linkow, Judy, of art in human life and its relation to implant dentistry. It
Niznick, Straumann, Misch, and others has solved many shows how implant dentistry uniquely combines science
chronic clinical problems that were heretofore untreat- and art to achieve a functional, aesthetic result. It is worth
able. Dental implants are becoming sometimes the only noting that this field requires not only clinical knowledge
predictable alternative treatment for many clinical situa- but also artistic talent to provide satisfactory results.
tions, and their long-term success over time has been well The second chapter concentrates on the presurgical
established. New implant designs with improved surgical planning for aesthetic cases, from evaluations of the
and prosthodontic options have extended the benefits of study cast to the fabrication of the surgical template. The
implant dentistry to patients previously excluded from chapter highlights the available treatment options and
therapy due to anatomical limitations or other reasons. explains why one treatment option should be selected
Today, countless numbers of patients with partial and over another. It also covers the provisional stage prepara-
full edentulism have experienced dramatic improvements tion for the patient receiving an implant-supported pros-
not only in clinical function, but also in their appearance, thesis in the aesthetic zone; hence, the chapter focuses on
social interactions, and personal self-confidence as a much more than aesthetic case planning.
direct result of successful implant therapy. In that vein, The third chapter of this book addresses dental
modern dental implantology may be considered the implant anatomy, the importance of implant positioning
treatment modality of the twentieth century, and it on the alveolar ridge, and how the three-dimensional
promises to yield even greater advancements in the new placement of an implant can be vital to the final treat-
millennium. ment outcome. It also addresses the clinical challenges
Concurrent with the refinement of the scientific aspects and options for addressing implant misplacements.
of dental implants, many renowned clinicians around the The fourth chapter of this book concerns soft tissue
world, such as Lazara, Bragger, Potashnick, Hurzeler, management around dental implants. It is the largest
Belser, Tarnow, Salama, Bengazi, Sclar, Wohrle, Saadoun, chapter of the book and presents most of the soft tissue
Grunder, Bitchacho, Geovanovick, Kan, Zitzmann, and techniques that are currently available. I have divided the
others, have made invaluable advancements in the science topic into four categories, each of which relates to the
of aesthetic implantology. Through the contributions of timing of clinical intervention. The chapter focuses on
these master artists, dentists no longer need to make the many clinical techniques that can be important for the
painful compromise between providing the patient with reader and includes guidelines for second-stage surgery,
function at the expense of appearance, or vice versa. I soft tissue grafting, papilla regeneration, and soft tissue
have greatly benefited from their contributions. enhancement procedures.
I offer in this present work an overview of the beauty The fifth chapter of this book provides information on
and artistic qualities that may be achieved with dental aesthetic bone reconstruction and presents the methods
implants. The surgical and reconstructive aspects of aes- for grafting the alveolar ridge to attain an optimal aes-
thetic dental implant restorations are presented, along thetic result. The chapter emphasizes the use of titanium
IX