10 March 2023

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Aesthetic management in lower anterior segment with a monobloc zirconia implant

Saurabh Gupta

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Introduction

Growing health concerns of patients have led to increasing demand for metal-free restorations. The same is true for dental implants. As dental professionals it is our goal to fulfil this demand of our patients in the most predictable way. The two most crucial aspects regarding treatment success are the osseointegration of the implant and the prosthetic workflow. 

The following case report outlines the replacement of two lower anterior teeth using a single monobloc AWI zirconia implant. 

Case report

A 42-year-old male patient presented at our office, asking for a replacement for two lower anterior teeth which were extracted seven years ago. As a part of this case the missing lower anterior teeth with respect to #31 and #41 were replaced (Figures1a, 1b, 2). We planned to restore the site with an AWI one-piece ceramic implant and two joint crowns due to insufficient space for two implants.  

Surgical phase

Following local anesthesia, the drilling protocol for bone was used, which includes a cortical drill and a screw tap, and the AWI monocloc implant was placed. Primary stability of 30 Ncm was achieved following the placement of implant (Figures 3, 4). 

Sutures were removed 10 days post-surgery. Healing was uneventful. 

Prosthetic phase

The prosthetic phase was started four months after the implant placement (Figures 5a, b). Silicon impression was taken, and two monolithic zirconia crowns were fabricated (Fig.6). The final restoration was cemented.

Clinical outcomes 

The result was outstanding with excellent tissue healing, and the patient was highly satisfied. No inflammation or any prosthetic problems occurred during the follow-up time period (Fig.7). The result in this anterior replacement case was a 100% metal-free implant and crowns. 

Conclusion 

Due to rising complications observed in some clinical situations involving the use of titanium dental implants and the rising incidence of peri-implant mucositis and peri-implantitis affecting the short- and long-term survival rates of titanium dental implants, the use of zirconia has been shown to have similar integration success when compared with titanium. Zirconia offers a soft-tissue response that is superior to that of titanium, and has less of an affinity to collect plaque or biofilm when compared with titanium surfaces.

Also, the peri-implant soft tissue around titanium and zirconia abutments showed color differences when compared to the soft tissue around natural teeth. The peri-implant soft tissue around zirconia demonstrated a better color match to the soft tissue than titanium. This can be extrapolated to the esthetics of the color of the implant itself. 

Zirconia implants can be used in these esthetic situations, with the white shade of the implant eliminating any potential for darkening of the gingival tissue and providing a more natural final esthetic result than possible with titanium implants. Long-term studies are necessary to continue to evaluate the effectiveness and success rates of two-piece zirconia implants.