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Questions and Answers
What skeletal patterns may contraindicate patients for dental implants without prior corrections?
What skeletal patterns may contraindicate patients for dental implants without prior corrections?
What is the ideal midcrestal position of the edentulous site relative to the facial CEJ of adjacent teeth?
What is the ideal midcrestal position of the edentulous site relative to the facial CEJ of adjacent teeth?
What is the minimum mesiodistal space required for a two-piece implant?
What is the minimum mesiodistal space required for a two-piece implant?
Which factor does NOT influence the final aesthetic outcome of an implant insertion?
Which factor does NOT influence the final aesthetic outcome of an implant insertion?
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What is the typical range of interproximal bone height above the midfacial scallop according to Becker et al.?
What is the typical range of interproximal bone height above the midfacial scallop according to Becker et al.?
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What is a treatment contraindication associated with the square shaped maxillary anterior teeth in relation to implant insertion?
What is a treatment contraindication associated with the square shaped maxillary anterior teeth in relation to implant insertion?
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Which characteristic is true regarding the facial width changes in triangular shaped teeth?
Which characteristic is true regarding the facial width changes in triangular shaped teeth?
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How does the bone height consideration differ for triangular shaped teeth compared to square shaped teeth?
How does the bone height consideration differ for triangular shaped teeth compared to square shaped teeth?
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What aspect of crown height space is most influenced by the high lip line in relation to maxillary anterior teeth?
What aspect of crown height space is most influenced by the high lip line in relation to maxillary anterior teeth?
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What is a key consideration in mesiodistal space related to triangular shaped maxillary anterior teeth?
What is a key consideration in mesiodistal space related to triangular shaped maxillary anterior teeth?
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Study Notes
Maxillary Anterior Crown Cervix
- Mesiodistal cross-section ranges from 4.5 to 7.0 mm.
- Never completely round.
Crown Height Space
- Poor candidates for dental implants include patients with Angle’s Class II Division II skeletal patterns, inadequate maxillomandibular relationships, or severe vertical dimension deficiencies.
- Orthognathic surgery, orthodontic therapy, or both may be necessary before implant placement.
Mesiodistal Space
- An adequate mesiodistal space is crucial for aesthetic implant restorations and interproximal soft tissue health.
- Smallest-diameter implant body: 3.2 mm.
- Crest module of two-piece implants: 3.5 mm or more.
- Mesiodistal edentulous space for a two-piece implant: 6.5 mm or greater.
- Average maxillary lateral incisor: 6.6 mm.
- One-piece dental implants may be fabricated in 2.5- to 3.0-mm diameters for reduced mesiodistal dimensions.
Bone Height
- The available bone influences soft tissue drape, implant size, position (angulation and depth), and the final aesthetic outcome.
- Ideal midcrestal position of the edentulous site: 2 mm below the facial CEJ of adjacent teeth.
Interproximal Bone
- Scalloped shape.
- 3 mm more incisal than the midcrestal position.
- Range of interproximal bone height above the midfacial scallop: less than 2.1 mm to more than 4.1 mm.
- Flat anatomy (less than 2.1 mm): square tooth shape.
- Scalloped anatomy (2.8 mm): ovoid tooth shape.
- Pronounced scalloped anatomy (4.1 mm): triangular-shaped tooth.
- When a flat interdental-to-crest dimension is found with triangular teeth, the interproximal space is often not filled with soft tissue.
Tooth Shape
- Three basic shapes: square, ovoid, and triangular.
- Tooth shape influences interproximal contact and gingival embrasure.
- Square tooth shape is the most favorable for ideal soft tissue drape and papillae around the crown.
- Triangular teeth have a more incisal interproximal contact, steeper gingival scallop, are farther from the interproximal bone, and often have a space between the interproximal contact and the interdental papilla.
- Triangular teeth can lead to soft tissue liability and vanishing during the healing phases after implant surgery.
- Triangular teeth have roots positioned farther apart, thicker facial and interproximal bone, decreased risk of crestal bone loss after extraction, and better prognosis for immediate implant insertion.
- Square teeth have less interproximal bone between the roots, greater risk of crestal or interproximal bone loss with immediate implant insertion, and less favorable for immediate implant insertion.
Soft Tissue Drape
- The height of the maxillary lip when smiling (high lip line) is crucial for evaluating the cervical region of maxillary anterior teeth.
- Ideally, the maxillary lip should rest at the junction of the free gingival margin on the facial aspect of the maxillary centrals and canine teeth, with visible interdental papillae and minimal gingival display.
- A "gummy smile" displays more than 2 mm of soft tissue above the clinical maxillary crowns.
- Maxillary first premolars often require bone grafts to prevent recessed emergence profiles.
- Second premolar apices may be located over the mandibular neurovascular canal or maxillary sinus, resulting in reduced bone height and shorter implants.
First-Molar Implant Replacement
- Mesiodistal dimension ranges from 8 to 12 mm.
- Placing one 4-mm-diameter implant can create a 4- to 5-mm cantilever on the marginal ridges, potentially causing bone loss, complicated home care, increased abutment screw loosening, and increased abutment or implant failure.
- Sullivan reported a 14% implant fracture rate for single molars fabricated on standard-diameter Nobel Biocare implants.
- Larger-diameter implants enhance mechanical properties, increase surface area, provide stronger resistance to component fracture, increase abutment stability, and improve emergence profile.
- Langer et al. recommended wide-diameter implants for poor bone quality or failed implant replacements.
- For mesiodistal dimensions of 14 mm or greater, two 4-mm-diameter implants are recommended for stress reduction and lower risk of abutment screw loosening.
- Balshi et al. compared the use of one implant and two implants to replace a single molar, finding a 99% 3-year cumulative success rate.
- For mesiodistal spaces of 12 to 14 mm, additional space can be gained through enamplasty of the adjacent teeth's proximal contours or orthodontics.
- Implants can be placed buccal and diagonal to the lingual to optimize placement within the crestal width of bone.
Aesthetic Maxillary Anterior Tooth Replacement
- Maxillary single-tooth replacement is highly challenging.
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Description
This quiz explores the essential aspects of maxillary anterior crown cervix, crown height space, and mesiodistal space for dental implants. It discusses the implications of skeletal patterns and the requirements for implant placement, including dimensions and spatial considerations. Perfect for students and professionals in dentistry.
