Replacement of an implant and prosthesis in the premaxilla due to a malposition and prosthetic failure: a clinical case letter.

I n the early years of modern implantology, the chief concerns of implantation success were tissue health and implant survival. 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. 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. 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 and satisfaction, but also the esthetic result of the implant. 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). 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, 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. 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: elliotkosDDS@gmail.com DOI: 10.1563/AAID-JOI-D-12-00124