Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept
The esthetic rehabilitation of anterior ridge defects and achieving patient satisfaction have become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures that fail to meet patient expectations. The loss of hard and soft tissues in anterior ridges results in an esthetically compromised zone that affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment plan considering esthetic parameters, prosthetic needs, and morphological defects must be used to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects that focuses on digital evaluation systems and is guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for esthetic outcomes and treatment alternatives for anterior ridge defects are also addressed.
(a) The optimal facially oriented tooth position and proportion is transferred from the 2D smile frame to the implant planning. The deficiency severity can be inspected in the CBCT from different planes (ie, axial, coronal, sagittal). (b) The 3D digital wax design of the prosthetic gingival restoration oriented by the diagnosis of the deficiency morphology and the esthetic goals.
Reconstruction of hard and soft tissue loss. (a) initial clinical situation of anterior ridge deficiency with severe loss of hard and soft tissue lack; (b) implant placement after bone and soft tissue graft; (c) use of prosthetic gingiva to replace the bone defect without further graft procedures.
(a) Initial clinical situation of anterior ridge deficiency due to traumatic injury and tooth loss, leading to disharmony in the gingival margin and lack of papilla volume. (b); 2 implants were installed in the region of #7, #8, and #9 received full-crown preparation; (c) esthetic outcome obtained with dentogingival implant-supported interim prosthesis. (d, e) esthetic integration and patient satisfaction achieved with 3D facially driven treatment plan.
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