The impact of the Visagism concept in implant dentistry

Background: Nowadays, implant treatment in the aesthetic zone is made according to anatomical and esthetic rules. There are a number of criteria for deciding the design of the future construction and smile. Software options give different approaches for making the measurements for the size, shape, and the correct position of each tooth, taking into account the golden rules of aesthetic and proportion. It has also been proven that the psychology and characteristics of the personality give the smile specific look, which is represented in the concept of Visagism. Aim: To determinate the position of the implant according to the future smile design, based on the face reading and the psychology of the patient. Materials and Methods: 34 implants were placed on 21 patients in the in the aesthetic zone. The vertical position of each implant was placed at a distance between 2 and 3 mm of the CEJ of the future restoration. For the smile design, computer software was used which uses the facial reading as well as the psychological characteristics and wishes of the patient according to the Visagism concept. Based on that project, a wax-up was created in the dental technician lab, and a surgical guide for the implant site preparation was prepared. The first provisional was designed in order to create a volume of soft tissues around the implant, and a second provisional according to the smile design was placed for a final contouring of the gingival margin. After the final soft tissue contouring, an impression was taken, and a final restoration was designed, following the recommendations of the software. Results: All of the 32 implants were positioned in the bone according to the guide, based on the anatomical background and the project of the final restoration. All the implants were perfectly ossteointagrated, and there was no bone loss or soft tissue remodeling after the 3-year recall period. All patients were satisfied with the design of the smile that was proposed by the Visagism software. The two provisionals concept created stabile and well designed soft tissue contour. Conclusion: The concept of planning implant position according to the Visagismile software and soft tissue management with two provisional restorations is a way to achieve predictable aesthetic results. Keywords: Visagism, implant treatment, planning of the implant position, aesthetic result