Reconstruction of the hard and soft tissues for optimal placement of osseointegrated implants

Success, as it is usually defined for osseointegrated implants, may leave much to be desired in terms of esthetics, phonetics, and function. Optimal occlusal function demands that the implant-supported restoration be placed in a position that will permit the desired cusp-fossae relations with axial loading. In the partially edentulous patient, the implant-supported restoration also should blend into the arch form of the adjacent and opposing teeth. From a phonetic viewpoint, the natural contour and position of the anterior teeth must be maintained. To achieve these goals, it may be necessary to restore the hard and soft tissue anatomy vertically and horizontally and to augment or reconstruct the sinus. Depending on the circumstances, these measures may be carried out before, during, or after implant placement. In this paper, the considerations involved in diagnosis and selection of reconstructive technique are outlined.