Dental News - Interview: “Implant therapy in the aesthetic zone is fraught with pitfalls”

Franziska Beier, DTI

Fri. 27. September 2019

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With his presentation, Dr Homa Zadeh contributed to a session that considered the theme “Should we avoid implants in the aesthetic zone?” in the scientific programme of the 28th Annual Scientific Meeting of the European Association for Osseointegration. He is a diplomate of the American Board of Periodontology and a past President of the Western Society of Periodontology. In a short interview with Dental Tribune International, Zadeh discussed the challenging aspects of placing implants in the aesthetic zone and the accompanying expectations of the patient.

Dr Zadeh, you gave a lecture titled “Placing implants in the aesthetic zone”. On what topics did you focus during your presentation?
My presentation focused on the decision-making process as the most important aspect of implant therapy in the aesthetic zone. There are dozens of decisions that have to be made that can affect the outcome. The bases on which those decisions are made were the focus of my presentation.

What are the pros and cons of implants in the aesthetic zone, and what are the specific challenges of placing implants in the aesthetic zone?
Implant therapy in the aesthetic zone is fraught with pitfalls, such as the variability of healing of tooth extraction sockets, as well as the variability of peri-implant mucosal changes. Implant installation is far more challenging in the anterior maxilla compared with other oral sites, whether implants are placed in extraction sockets or in healed sites. The combination of biological variability in outcomes, as well as technical challenges, can increase the likelihood of a negative outcome.

However, rather than avoiding implants in the aesthetic zone altogether, it is important for clinicians to perform a thorough risk assessment in order to understand the risk factors and risk indicators that can influence the outcome.

Important risk factors discussed included the alveolar bone phenotype of the extraction sockets (i.e. thin is less than 1 mm and thick greater than 1 mm) and the mucosal phenotype. Also, the 3D implant position has to be based on both anatomical and prosthetic guidelines. By recognising all of these elements of risk, it is possible to manage them by proper decision-making and to maximise the predictability of the outcome.

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How do patients’ expectations of implants in the aesthetic zone vary from their expectations of implants elsewhere in the oral cavity?
Any therapy in the anterior maxilla has very little leeway for error because the outcome is directly visible by the patient and others. Implant therapy in the aesthetic zone is extra challenging, because the outcome is a reflection of both the surgical and the prosthetic therapy performed.