Table of Contents

1. Introduction

2. Consensus Statements: Statements and Recommendations Obtained from the 5th ITI Consensus Conference
2.1. Contemporary Surgical and Radiographic Techniques in Implant Dentistry
2.2. Restorative Materials and Techniques for Implant Dentistry
2.3. Optimizing Esthetic Outcomes in Implant Dentistry
2.4. Implant-loading Protocols
2.5. Prevention and Management of Biological and Technical Implant Complications

3. Preoperative Risk Assessment and Treatment Planning for Optimal Esthetic Outcomes
3.1. Patient Selection
3.1.1. SAC Classification for Single-tooth Replacement

3.2. Esthetic Risk Assessment
3.2.1. Medical Status
3.2.2. Smoking Habit
3.2.3. Gingival Display at Full Smile
3.2.4. Width of the Edentulous Span
3.2.5. Shape of Tooth Crowns
3.2.6. Restorative Status of Adjacent Teeth
3.2.7. Gingival Phenotype
3.2.8. Infection at the Implant Site
3.2.9. Soft-tissue Anatomy
3.2.10. Bone Level at the Adjacent Teeth
3.2.11. Facial Bone-wall Phenotype
3.2.12. Anatomy of the Alveolar Crest
3.2.13. Patients' Esthetic Expectations

3.3. Treatment Planning
3.3.1. Anatomical Considerations
3.3.2. Indications for CBCT in the Esthetic Zone
3.3.3. Digital or Conventional Planning
3.3.4. Surgical Templates for Implant Placement

4. Selecting Biomaterials for Implant Procedures
4.1 Ceramic vs. Titanium Implant Materials
4.1.1. Commercially Pure Titanium Implants
4.1.2. Titanium-alloy Implants
4.1.3. Ceramic Implants

4.2. Bone Grafts and Bone Substitute Materials
4.2.1. Autologous Bone Grafts
4.2.2. Allografts
4.2.3. Xenografts
4.2.4. Alloplastic Bone Substitutes

4.3. Biologics
4.3.1. Growth Factors
4.3.2. Enamel Matrix Derivative
4.3.3. Autologous Platelet Concentrates

4.4. Membranes
4.4.1. Non-resorbable Membrane
4.4.2. Resorbable Membranes
4.4.3. New Development in Membranes with a Functionally Graded Structure

5. Surgical Considerations for Optimal Esthetic Outcomes
5.1. Post-extraction Dimensional Ridge Alterations in the Esthetic Zone
5.1.1.  Flapless Low-trauma Tooth Extraction to Reduce Dimensional Alterations
5.1.2.  Post-extraction Dimensional Alterations of the Hard Tissues
5.1.3.  Post-extraction Dimensional Alterations of the Soft Tissues

5.2. Indications for Post-extraction Ridge Preservation
5.2.1.  Ridge Preservation by Root Maintenance
5.2.2.  Ridge Preservation by Socket Grafting

5.3. Indications for Soft-tissue Grafting
5.3.1.  Increasing the Band of Keratinized Mucosa
5.3.2.  Improving the Soft-tissue Volume

5.4. Flap Design and Suture Techniques
5.4.1. Flapless Approach
5.4.2. Elevation of a Mucoperiosteal Flap

5.5. Implant Selection
5.5.1. Selection Criteria for Soft-tissue-level (STL) vs. Bone-level (BL) Implants in the Anterior Maxilla
5.5.2. Implant Diameters in the Anterior Maxilla
5.5.3. Implant Lengths in the Anterior Maxilla

5.6. Correct Three-dimensional
5.6.2. Orofacial Dimensions
5.6.3. Coronoapical Dimensions
5.6.4. Implant Angulation

5.7. Surgical Approach: Simultaneous vs. Staged GBR
5.7.1. Simultaneous GBR
5.7.2. Staged GBR

5.8. Surgical Approach: Immediate vs. Early vs. Late Implant Placement
5.8.1. Immediate Implant Placement (Type 1)
5.8.2. Early Implant Placement (Type 2 and 3)
5.8.3. Late Implant Placement (Type 4)

6. Prosthetic Management for Optimal Esthetic Outcomes
6.1. Evaluation of Esthetic Outcomes in Single-tooth Replacement
6.2. Interim Prostheses
6.2.1. Before Implant Placement
6.2.2. After Implant Placement

6.3. Management of Peri-implant Tissue
6.3.1. Shaping the Transition Zone
6.3.2. Capturing the Transition Zone

6.4. Laboratory Communication
6.4.1. Photography Records
6.4.3. Prescription

6.5. Screw-retained vs. Cemented Restorations

6.6. Material Selection for Abutments and Crowns
6.6.1. Prefabricated Abutments
6.6.2. Cast Custom Abutments
6.6.3. CAD/CAM Custom Abutments
6.6.4. Original vs. Non-original
6.6.5. Abutment Materials
6.6.6. Biocompatibility
6.6.7. Influence on Esthetics
6.6.8. Physical Properties

6.7. Prosthetic Design
6.7.1. Crown/Veneer Materials

6.8. Handling of Abutments and Restorations

7. Clinical Case Presentations
7.1. Replacement of a Failing Upper Left Central Incisor: Immediate Placement of an RC Bone Level Implant and Provisionalization
7.2. Replacement of a Perforated Upper Left Central Incisor: Early Placement of an RC Bone Level Implant
7.3. Replacement of an Upper Right Central Incisor with a Root Fracture: Early Placement of an RC Bone Level Implant, Variobase Abutment
7.4. Replacement of a Failing Upper Right Central Incisor: Ridge Preservation and Late Placement of a NC Bone Level Implant
7.5. Replacement of an Upper Right Central Incisor with Root Resorption: Ridge Preservation, Delayed Placement of an NC Bone Level Roxolid Implant
7.6. Replacement of an Upper Right Central Incisor with Root Resorption: Ridge Preservation, Early Placement of an RC Bone Level Implant
7.7. Replacement of an Ankylosed Central Incisor with a Gingival Recession: Tooth Extraction with Socket Grafting and Late Implant Placement with Simultaneous Contour Augmentation
7.8. Replacement of a Compromised Upper Right Central Incisor: Hard- and Soft-tissue Augmentation, Late Placement of an RC Bone Level Implant
7.9. Replacement of a Failing Restored Upper Right Central Incisor: Ridge Preservation and Early Placement of an RC Bone Level Implant
7.10. Replacement of a Fractured Upper Left Central Incisor: Delayed Placement of a Bone Level Tapered Implant Using a Staged Approach
7.11. Replacement of an Ankylosed Upper Left Central Incisor: Bone Augmentation and Socket Grafting, Late Placement of an RC Bone Level Implant
7.12. Replacement of a Missing Upper Left Central Incisor: Late Placement of an RC Bone Level Implant, CAD/CAM Zirconia Abutment
7.13. Replacement of a Missing Upper Left Central Incisor: Late Placement of an RC Bone Level Implant and Adjacent Tooth Restoration
7.14. Replacement of a Fractured Upper Left Central Incisor: Early Placement of a Monotype Zirconia Implant, Semi-submerged Transmucosal Healing

8. Esthetic Complications
8.1. Causes of Esthetic Complications
8.1.1. Incorrect 3D Implant Position
8.1.2. Implant Selection
8.1.3. Insufficient Facial Bone Wall
8.1.4. Esthetic Failure Due to Late Facial Growth
8.1.5. Esthetic Failure Due to Implants and Third-party Implant Components Lacking Scientific Validation

8.2. Management of Esthetic Complications
8.2.1. Decision Criteria for Salvaging Esthetic Implants
8.2.2. Criteria for Implant Removal

9. Conclusions

10. References 


ITI International Team for Implantology
ITI Headquarters
Peter Merian-Strasse 88
4052 Basel
Switzerland

Phone +41 61 270 83 83
Fax +41 61 270 83 84
E-Mail headquarters@iti.org 

ITI International Team for Implantology | Peter Merian-Strasse 88 | 4052 Basel | Switzerland | Phone +41 61 270 83 83 | Fax +41 61 270 83 84 | headquarters@iti.org