Idealizing Implant Sites

Whether teeth are lost directly as a result of disease or trauma or extracted as a planned part of treatment, their loss has a direct and often significant effect on the dimensions of the alveolar ridge as atrophic changes occur over time. In order to place an implant, the bone at the site must meet minimum biologic width and height requirements as well as present with sufficient density. Failure to adhere to these evidence-based guidelines can affect the ability to properly restore an implant as well as the esthetics of the restoration and result in a host of complications and failure modes, including the potential for fracture under load. Similarly, the soft tissue at an implant site requires a minimum amount of keratinized mucosa to be present in order to protect the implant/bone interface and optimize the esthetics. An insufficient quantity of keratinized mucosa can lead to recession and increase the recipient's risk of developing conditions such as peri-implant mucositis and peri-implantitis, which can ultimately result in failure of the implant.

Narrow diameter implants, angled abutment platforms, and other advancements have been developed to offer solutions in extremely challenging cases, but these products don't obviate the need for appropriate hard- and soft-tissue development when and where it is possible. To reduce the risk of complications and contribute to the long-term success of implant-retained restorations, a variety of protocols are available to clinicians to improve the quantity and quality of the hard and soft tissue at implant sites both in advance of and at the time of implant placement.

Inside Dentistry's October cover story examines the importance of implant site development, discusses the effect of hard- and soft-tissue factors on implant success, and explores the pros and cons of some of the options available for alveolar ridge augmentation, including autografts, allografts, xenografts, alloplastic materials, and patient-derived blood products. In addition, this issue includes a continuing education offering on fiber-reinforced post and core techniques, a pediatric piece on the treatment of lingual pit caries in teeth affected by dens invaginatus, and many more informative articles to help you improve your practice. I hope you enjoy it!

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com