Three-dimensional positioning of implants: A focus on esthetics

Patients may not always be completely satisfied with the esthetic result of their implant treatment and restorations. They may have had unrealistic expectations with regard to expected treatment outcomes but their dissatisfaction may also have its roots in insufficient treatment planning and incorrect implant positioning. Marginal tissue recession and proximal papilla loss may be the result. In many cases, however, compromised esthetic outcomes can be avoided by appropriate surgical measures being taken at the time of implant insertion. Prosthetically guided implant insertion in an anatomically defined three-dimensional position allows treatment providers to reduce the incidence of esthetic problems. The present article examines different surgical protocols on the basis of recent publications, discusses pertinent biological fundamentals and gives recommendations for three-dimensional implant positioning, taking the local anatomical situation and the future prosthetic superstructure into due account. It also analyzes predictability and reproducibility aspects of an esthetic implant treatment.