Dental implant therapy in the aesthetic zone

Implantoprotetska terapija u estetskoj zoni karakterizirana je složenim i dugotrajnim terapijskim protokolom koji zahtijeva multidisciplinaran pristup uz preciznu analizu, dijagnostiku, izradu plana terapije te njezino provođenje. Oralni kirurg i protetičar u suradnji sa zubnim tehničarom moraju integrirati svoja znanja i vještine u svrhu postizanja estetski i funkcionalno zadovoljavajućih rezultata. S obzirom na veliku varijabilnost izgleda osmijeha svakog pacijenta, individualan je pristup ključan te zahtijeva detaljan klinički pregled uz analizu Cone Beam Computed Tomography (CBCT) snimke. Trodimenzionalana CBCT snimka omogućuje pravilno pozicioniranje implantata u svim dimenzijama, što uvelike utječe na terapijski ishod s estetskog, ali i funkcijskog stajališta. Nakon adekvatno obavljene implantacije, a time i završene kirurške faze terapije, na snagu stupa specijalist stomatološke protetike. Kako bi pacijentu u vrijeme trajanja cjelokupnoga terapijskog protokola osigurao prihvatljiv izgled osmijeha te kako bi omogućio modelaciju izlaznoga profila, on pristupa izradi privremenog nadomjestka. Faza modelacije izlaznog profila periimplantatnih tkiva ključan je čimbenik za zadovoljavanje zahtjeva „crvene” estetike. Postignuti oblik izlaznog profila registrira se i prenosi u zubotehnički laboratorij otisnim postupkom uz individualiziran otisni transfer. Kako bi se udovoljilo zahtjevima „bijele” estetike, najveća se pozornost obraća se na izbor materijala čijom se uporabom mogu izraditi nadomjestci koji svojim izgledom oponašaju optička obilježja prirodnih zuba. Stoga se u estetskoj zoni za izradu individualne implantatne nadogradnje prednost daje cirkonijoksidnoj keramici zbog dobrih mehaničkih i estetskih svojstava. Materijal izbora za izradu krunice u estetskoj je zoni litijdisilikatna keramika zbog svojih iznimnih optičkih obilježja. Konačan rezultat terapije mora osigurati potpun sklad između protetskog nadomjestka na implantatu, periimplantatnih tkiva te prirodnih zuba, odnosno potpuno zadovoljenu „crveno-bijelu“ estetiku.Dental implant therapy in the aesthetic zone is characterized by a complex and long-lasting therapeutic protocol that requires a multidisciplinary approach with precise analysis, diagnostics, development of the treatment plan and its implementation. An oral surgeon and prosthetist, in collaboration with a dental technician, must incorporate their knowledge and skills in order to achieve aesthetically and functionally satisfactory results. Concerning the large variety of different smiles of each patient, the crucial thing is a personalized approach and it requires a detailed clinical examination with analysis of Cone Beam Computed Tomography (CBCT) image. Three-dimensional CBCT image enables the correct positioning of the implant in all dimensions, which greatly affects the therapeutic outcome from the aesthetic as well as functional point of view. After an adequately performed implantation which completes the surgical phase of therapy, a specialist in dental prosthetics starts his part of the job. In order to provide the patient an acceptable appearance during the entire therapeutic protocol, and also to allow modelling of the output profile, the specialist initiates making of a temporary replacement. The modeling phase of the output profile of surrounding tissue is the key factor in meeting the requirements of the "red" aesthetics. The achieved shape of the output profile is registered and transferred to the dental laboratory by an imprint procedure with an individualized imprint transfer. In order to meet the requirements of the "white" aesthetics, the greatest attention is paid to the choice of materials that can be used to make substitutes that in appearance resemble the optical properties of natural teeth. Therefore, in the aesthetic zone of making individual implant upgrades zirconium-oxide ceramics is preferred due to their good mechanical and aesthetic properties. The material for making the dental crown in the aesthetic zone is lithium di-silicate ceramics due to its exceptional optical properties. The final result of therapy must ensure complete harmony among the prosthetic implant replacement, the tissues that surround the implants and the natural teeth