Tissue-Directed Placement of Dental Implants in the Esthetic Zone for Long-Term Biologic Synergy: A Clinical Report

Implant dentistry steadily evolves as more is learned about the unique biologic interrelationship of the dental implant restoration and the surrounding hard and soft tissues. Important factors include the impact of the surface microtopography on biochemically-mediated cell differentiation, the unavoidable bacterial colonization of the implant-abutment (or crown) microgap, the vertical and horizontal dimensions of biologic width, and the histology of surrounding structures. The recipient site, implant design, surgical technique, and location of the restorative platform significantly influence the optimal esthetics and biologic stability of implant restorations. There are differing opinions among clinicians regarding the appropriate positioning of the implant restorative platform in the vertical and sagittal planes relative to the alveolar crest. An apical and palatal orientation of the coronal platform relative to the alveolar crest in the esthetic zone is generally advocated for favorable facial and proximal emergence profiles of the definitive crown. Tissue-directed implant placement primarily considers the long-term consequences of the implant restoration upon the surrounding hard and soft tissues. The goal is to develop optimal gingival contours and a definitive restoration in the esthetic zone that coexist in stable biologic synergy. The rationale and the specific prosthodontic and surgical protocols inherent in the tissue-directed concept are discussed in this report. Keywords: biologic width, dental implants, gingival morphology, implant-supported dental prostheses, interdental papilla, osseous morphology, ovate pontics, single-stage implants