Aesthetics of dental implants - periodontal and surgical aspects

Aesthetic effect of definitive restorations on dental implants is the most important aspect of oral rehabilitation. To ensure satisfactory aesthetic when performing implant treatment, different biological, periodontal and surgical concepts should be taken into account. The most common reasons for implant placement in the aesthetic region are considered to be extraction of the front teeth due to unsuccessful endodontic treatment or as a consequence of advanced periodontal disease. Taking into account the aforementioned factors, as well as the growing importance of aesthetics in modern society, the main goal of this research was set - to make an analysis of the relevant periodontal and surgical factors that affect the aesthetics of superstructures worn by dental implants. Adequate literature research was performed to fulfill the main goal. Sources of information used in this study were obtained from the most used of all scientific databases- Pub Med. All of the used literature data was previously published in peer-reviewed publications and journals. Most of the articles used for this literature review have been published in English and cover the period from the last two decades 2001 to 2021. Numerous factors have been identified as influencing on the satisfactory aesthetics of definitive work and long-term success in oral implantology. First ones are periodontal and are related to: gingival morphological aspects and positioning, periodontal biotype, position of the lower lips in a relaxed state and while smiling and interocclusal space. The second group is connected to the surgical interventions such as: regeneration ability of soft tissues and alveolar bone, placing the implants in the correct position and absence of the need to lift the flap. The third group of factors is those related to prosthetic rehabilitation such as morphology and relationships of superstructures, the relationship of prosthetic devices with the surrounding soft tissues and proper planning of prosthetic devices. The thickness of the buccal side of the alveolar processus after implant placement, after few or longer time, is the most important prognostic factor in the aesthetic aspect. Surgical adherence to the buccal wall of the alveoli is the most important factor in obtaining a satisfactory aesthetic result. Except the resorption of the alveolar bone, another aspect is the fact that the final aesthetic result correlates with the morphology and width and biotype of the gingiva. This refers primarily to the possibility of recession of the gingiva on the buccal side after the definitive placement of the suprastructure. Adequate handling of soft and bone tissues during implant therapy has extremely importance. Proper planning and management of oral tissues can suppress the occurrence of numerous intra and postoperative complications and thus affect the patient's quality of life in the postoperative period. During the planning of implant placement regardless of whether it is immediate or delayed-loading implants it is necessary to have adequate manipulation of the surrounding soft tissue and bone structures. Minimally invasive procedures have become a new paradigm in dental medicine. The main idea and concept of this approach is preservation of tissues, with at least damage to the surrounding tissue structures on the one hand and the most precise on the other. At the end of the surgical procedure, all the bony parts of the alveoli that protrude above the edges should be removed or covered with movable sutures on the mucous membrane, which should then be sutured. Also, crushed, traumatized and thermally unprotected bone should be removed. In conclusion we can note that the establishment of proper aesthetics of superstructures worn by dental implants largely depends on the knowledge of biological, periodontal and surgical aspects