Journal of Oral Implantology December 2014 - (Page 751)

CASE LETTER Replacement of an Implant and Prosthesis in the Premaxilla Due to a Malposition and Prosthetic Failure: A Clinical Case Letter Vito A. Cardo, Jr, DDS1 Elliot Koschitzki, DDS2* Nachum Augenbaum, DDS2 Jenna L. Polinsky, DDS2 INTRODUCTION I n the early years of modern implantology, the chief concerns of implantation success were tissue health and implant survival.1 Over the last decade, there has been an increasing appreciation for how the resulting esthetics can be equally as important to the success of the final restoration as is health. Achieving an esthetic and functional implant-supported restoration in the maxillary anterior region can be challenging. In a review of the recent literature, Belser and colleagues reported that dental implants in the anterior maxilla have an overall survival and success rate similar to those reported for other segments of the jaw.2 Traditionally, the criteria of implant success rate was based upon an absence of persistent or irreversible signs and symptoms such as pain, infections, neuropathies, paresthesia, or violation of the mandibular canal. Implantation success can be further substantiated by vertical bone loss of ,0.2 mm annually after the first year of service of the implant and also that the implant does not demonstrate any evidence of peri-implant radiolucency.3 However, the American Dental Association Council on Dental Material Instruments and Equipment revised the criteria to include not only the patient's emotional and psychological attitude 1 Oral and Maxillofacial Surgery and Oral Implantology, Department of Dental & Oral Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York. 2 Oral Implantology and Biomaterials, Department of Dental & Oral Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-12-00124 and satisfaction, but also the esthetic result of the implant.4 Undesirable outcomes relating to an implant's location may affect the success and longevity of a prosthetic rehabilitation. These sequelae arise when implants are not optimally placed in one or more geometric planes (eg, buccolingually, mesiodistally, and apicocoronally).5 Increasing the apicocoronal position adds to the available running room and facilitates the staging of a restoration with gradual axial contours. However, an excess amount of running room can result in an elongated clinical crown with heightened potential for recession around the implant. In contrast, inadequate running room will result in a crown with a poor emergence profile. When the implant platform is positioned ,2 mm below the cementoenamel junction (CEJ) of the adjacent teeth, the porcelain of the crown may not be subgingival enough to mask the titanium color of the abutment. Therefore, the ideal position for an implant placed in the premaxilla should be 2 mm below the CEJ of the adjacent teeth. A site at this position corresponds to approximately 3 mm below the free gingival margin of the implant crown,6 a location that provides a proper emergence profile. Often an implant with inadequate running room in the aesthetic zone that does not have a proper emergence profile would have to be removed due to neglect of the aforementioned criteria. The object of this study is to present a case in which a failed implant due to poor esthetics and malposition was removed and replaced by an implant with appropriate running room and thus was restored with proper esthetics. Journal of Oral Implantology 751

Table of Contents for the Digital Edition of Journal of Oral Implantology December 2014

Effect of Splinting in Accuracy of Two Implant Impression Techniques
Assessment of the Stress Transmitted to Dental Implants Connected to Screw-Retained Bars Using Different Casting Techniques
Retentiveness of Various Luting Agents Used With Implant-Supported Prosthesis: An In Vitro Study
Role of rhBMP-2 and rhBMP-7 in the Metabolism and Differentiation of Osteoblast-Like Cells Cultured on Chemically Modified Titanium Surfaces
Coated vs Uncoated Implants: Bone Defect Configurations After Progressive Peri-implantitis in Dogs
Why Guided When Freehand Is Easier, Quicker, and Less Costly?
Advanced Platelet-Rich Fibrin: A New Concept for Cell-Based Tissue Engineering by Means of Inflammatory Cells
Flapless Alveolar Ridge Preservation Utilizing the ‘‘Socket-Plug’’ Technique: Clinical Technique and Review of the Literature
Implants Placed in the Nasopalatine Canal to Rehabilitate Severely Atrophic Maxillae: A Retrospective Study With Long Follow-up
Severe Mandibular Atrophy Treated With a Subperiosteal Implant and Simultaneous Graft With rhBMP-2 and Mineralized Allograft: A Case Report
Full-Mouth Rehabilitation of a Patient With Ectodermal Dysplasia With Dental Implants
The 2-Visit CAD-CAM Implant-Retained Overdenture: A Clinical Report
Assessment of Implant-Related Treatment With Edited Three-Dimensional Reconstructed Images From Cone-Beam Computerized Tomography: A Technical Note
Retrieval of a Separated Implant Screwdriver Fragment
Correction of Esthetic Complications of a Malpositioned Implant: A Case Letter
Fixed Partial Denture Treatment With Mini Dental Implants
Replacement of an Implant and Prosthesis in the Premaxilla Due to a Malposition and Prosthetic Failure: A Clinical Case Letter
A New Restorative Technique for the Perishing Implant Due to Abutment Screw Fracture
Fit of CAD/CAM Implant Frameworks: A Comprehensive Review

Journal of Oral Implantology December 2014