title: Managing esthetic challenges with anterior implants. Part 1: midfacial recession defects from etiology to resolution.
abstract: Dilemmas accompanying esthetic zone implants frequently involve a dehiscence type defect of the midfacial tissues. The challenge to the surgical-restorative implant team is to understand the etiology associated with such defects and the treatment options that can be offered lending to predictable outcomes. Etiologic factors are: 1) poor implant spatial positioning; 2) incorrect abutment contour; 3) excessive implant diameter; 4) horizontal biologic width formation; and 5) periodontal phenotype. Remediation treatment can involve: 1) burying the implant and allowing the soft tissues to heal naturally over the implant with a surgical cover screw known as implant decoronation; 2) augmentation of the soft tissues with a connective tissue graft, if needed; 3) stage 2 uncovering of the implant: and 4) controlling the abutment-crown contour appropriately with flat or even undercontour to maintain the soft tissues in a stable and healthy position long term.
authors.affiliation: Clinical Associate Professor, Director of Esthetic Education, Columbia University College of Dental Medicine, New York, New York.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Chu
authors.affiliation: Clinical Professor, Director of Implant Education, Columbia University College of Dental Medicine, New York, New York.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Tarnow
mesh_terms: D015921:Dental Implants; D004955:Esthetics, Dental; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D010348:Patient Care Team
chemical_list: D015921:Dental Implants