The Role of Implant Position on Long‐Term Success

Focused Clinical Question: In the past, implants were placed where the bone was. This mode of treatment often led to implant‐related complications, such as peri‐implant soft‐tissue recession, esthetic challenges, and fractured implants and/or associated suprastructures. Therefore, advances in soft‐tissue and bone augmentation techniques have enabled implants to be placed in an ideal three‐dimensional position, thus ensuring adequate peri‐implant soft tissue and bone thickness for a stable and successful long‐term treatment outcome. The present report aims to answer the question: What are the clinical guidelines for implant placement to achieve long‐term success? Summary: In the maxillary anterior region where esthetics is of paramount importance, 2 mm of buccal bone anterior to the implant is preferred. This ensures stability of the buccal bone plate, minimizing peri‐implant mucosal recession. To achieve an esthetic emergence profile, the implant platform is generally placed 3 to 4 mm apical to the cemento‐enamel junction (CEJ) of the adjacent teeth and 1.5 to 2 mm away from the adjacent roots. In the posterior region, a minimum of 1 mm of buccal bone around the implant ensures stability of the buccal plate. Generally, implants with a polished collar are preferred because the collar can be placed supracrestally to compensate for any vertical ridge deficiency and yet not compromise the esthetics of the restoration. The implant is placed 1.5 to 3 mm apical to the CEJ of the adjacent teeth and 3 to 4 mm away from adjacent roots to create a smooth transition from implant platform to occlusal plane. Conclusion: Ideal three‐dimensional implant positioning ensures a long‐term stable esthetic and functional treatment outcome.