Aesthetic Considerations in Implant Therapy - A Review

The success of dental implant depends on its integration with the surrounding tissue and this is influenced by various factors, like implant material, amount of bone and its quality and the implant loading condition. The peri-implant tissue is comprised of the soft (mucosa) and hard (bone) tissues. Absolute contact between the peri-implant bone and the implant surface is another factor essential for the success of any implant system. The direct structural and functional connection between ordered living bone and the surface of a load-carrying implant is defined as ''Osseointegration''. The bone undergoes remodelling so as to maintain bone strength and mineral homeostasis. The preservation of biological seal, the anatomy and quality of bone where implant needs to be positioned, implant macrostructure are some of the factors that dictate the integration of the implant to the hard tissue. In addition, the gingival morphology also plays an important role in determining the final aesthetic outcome. Gingival morphology is described in terms of gingival phenotype or gingival biotype. ‘‘Gingival phenotype’’ is a term that addresses to the variations in the thickness and width of the keratinized tissuewhereas ''Gingival biotype'' depicts the thickness of the gingiva in the facio-palatal / faciolingual dimension.Inadequate gingival thickness is a major reason for periodontal attachment loss and marginal tissue recession in a patient, directly contributing to the periodontal disease progression. The peri-implant soft tissue consists of a junctional epithelium (JE) and the connective tissue but owing to the biologic differences between the peri-implant and periodontal tissues, the periimplant tissues are more vulnerable to mucosal inflammation and bone loss. The health of the peri–implant tissues play an important role in the long-term outcome of dental implants. The preservation and reconstruction of soft tissue around dental implants is an important aspect of dental implantology. Restoring the function, aesthetics and harmony of dentition is the primary intention of implantology. This is achieved with a sound crestal bone stability and healthy peri-implant soft tissue. Other factors like abutment material and its connection to the implant, the neck design also affects the peri-implant soft tissue integrity. This review discusses the various factors that directly and indirectly influence the aesthetic outcomes following a dental implant placement. KEY WORDS Aesthetics, Peri-Implant Tissue, Osseointegration, Platform Switching