Course Description

Today osseointegration is considered routinely achievable ensuring a functional prosthetic result on dental implants should be within easy reach. The same cannot be said for achieving esthetics, with difficulties in implant design which do not conform to anatomy and of course the difficulties that arise with early bone loss and consequent loss of soft tissue architecture and papilla form. The widespread acceptance of an initial adaptation of the marginal bone down to the first thread has been challenged by the hypothesis that so-called platform switching accommodates an increased volume for the biologic width and thereby avoids bone loss. The maintenance of marginal bone is a more complex process than the accommodation of the connective tissue compartment. Rather it depends upon creating ideal conditions for bone to attach itself at the top of the implant, by means of the application of surface topography, through a biomechanical rationale for distribution of functional load through the implant, by eradication of unfavorable microbial leakage, by the creation of space for the connective tissue compartment and by enhancing the bone bonding properties of the implant surface. It will also depend on the implant-to-abutment junction and the use of site-specific abutment profiles to ensure the bone remains over the long-term. Ultimately the concept of prosthetically guided healing for soft tissue sculpting remains the key issue for esthetic success. The surgical options of staged versus immediate approaches also denote a choice between having to regain lost architecture versus maintaining an architecture that is already present. These issues will be discussed in depth, with appropriate examples. This presentation will focus on the concept of Bone Health by Design™ and explain how the implants help ensure true long-term maintenance of marginal bone not just for today but for up to three decades of clinical follow up.

Upon completion of this program, participants will be able to:

• ·Understand the key biological and biomechanical factors that contribute to long-term marginal bone maintenance around dental implants.
• ·Recognize the role of implant design, implant-abutment connections, and restorative components in supporting peri-implant hard and soft tissue stability.
• ·Understand surgical and restorative treatment approaches that help preserve or optimize esthetic outcomes through prosthetically guided healing and tissue management.