17-IMPLANT Esthetics

Implant Ethetics
Hassan Hussein Hassan ElHusseiny

Out Line
• Introduction
• Implant Position
• The Peri-Implant Mucosa
• Ridge Defects
• Socket Preservation Techniques
• The Interdental Papilla and gingival esthetics
• White and pink esthetics
• prosthetic consideration for white and pink esthetics concept
• Pink and white esthetic score
• Implant esthetic failures
Implant Esthetics
• Esthetically pleasing implant-supported restorations imitate
natural teeth appearance
• Peri-implant soft tissue should harmonize with adjacent teeth's
soft tissue profile
• Various techniques suggested to improve soft tissue esthetics
Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile

Design Integrating Esthetics and Function Essentials in Esthetic Dentistry.
2016 Jan.
techniques suggested to improve implant
esthetics
• Socket Preservation
• Soft Tissue Grafting
• Ridge Augmentation
• Provisional Restoration Design
Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile Design Integrating Esthetics and
Function Essentials in Esthetic Dentistry. 2016 Jan 1;21-42.
Socket Preservation
• Following tooth extraction, socket preservation

techniques can be employed to maintain the
dimensions of the extraction socket and minimize post-
extraction bone resorption.
• This helps to preserve the soft tissue architecture,

which can contribute to improved esthetics around the
implant site.
Darby, I. B., & Morris, K. H. (2013). Preservation of the Intact Buccal Wall in Extracted Socket Sites Using the
Socket-Plug Technique: A Clinical Report. International journal of periodontics & restorative dentistry, 33(3),
331-338.
Soft Tissue Grafting
• Soft tissue grafting procedures, such as connective tissue grafts

or free gingival grafts, can be performed to augment the soft
tissue volume around dental implants.
• These techniques help to create a harmonious transition

between the implant restoration and the surrounding gingiva,
resulting in improved esthetics.
Zuhr, O., Baumer, D., & Hurzeler, M. (2017). The Socket-Shield Technique: A Proof-of-
Principle Report. Journal of clinical periodontology, 44(4), 448-455
Ridge Augmentation
• In cases where the alveolar ridge lacks sufficient bone
and soft tissue volume, ridge augmentation
procedures.
• This involves the use of bone grafts and soft tissue

grafts to enhance the dimensions of the ridge,
providing a more esthetically pleasing outcome for
implant placement.
Wang, H. L., & Boyapati, L. (2006). “PASS” principles for predictable bone regeneration.
Implant dentistry, 15(1), 8-17.
Hard Tissue Augmentation Techniques
• Indicated when lack of bone interferes with proper implant
positioning.
• Block grafts for severe cases.
• Guided bone regeneration for mild to moderate defects.
Soft Tissue Grafts
• Used for correcting ridge defects in pontic areas.
• Free gingival onlay grafts for height increase.
• Subepithelial CT grafts for ridge width increase.
• Limited use in implant dentistry for mild horizontal defects.
Provisional Restoration Design
• The design and contour of provisional restorations can play a
significant role in shaping the emergence profile and guiding the
soft tissue during the healing phase.
• Well-designed provisional restorations can promote the

development of harmonious soft tissue contours around the
implant.
Kokich, V. G., & Kokich, V. O. (1997). Esthetics of

Anterior Fixed Prosthodontics. The Journal of
prosthetic dentistry, 77(3), 163-174.
Implant Position
• 3D planning of implant position is crucial for esthetic outcomes
• Implant position should consider the contour of adjacent natural

teeth.
• Gingival biotype plays a significant role, Thick gingival biotype
offers better opportunities for recreating good soft tissue
esthetics.
• Common errors:
• poor axial inclination and buccolingual position
• Implant position should consider the contour of adjacent natural teeth.
• Thick gingival biotype
Implant Positioning Guidelines
• Align implant long axis with the crown.
• Angles between 20° proclined and 10° retroclined are

acceptable.
• Minor errors can be corrected with angled abutments.
Vertical Position of Implant Head
• Smooth transition profile is important.
• Emergence profile depends on crown size, implant diameter,

and distance between implant head and crown cervical margin.
• Implant margin should be placed 3-4 mm apical to the soft

tissue level of adjacent teeth.
Levine JB, Finkel S. Esthetic diagnosis a three-

step analysis. Smile Design Integrating Esthetics
and Function Essentials in Esthetic Dentistry. 2016
Jan 1;21-42.
The Peri-Implant Mucosa
• The peri-implant mucosa is similar to natural teeth in
histological components and dimensions.
• Interaction between implant surface and supra-alveolar CT.
• Composition of peri-implant mucosa and its role as a

barrier.
Berglundh T, Lindhe J, Ericsson I, Marinello C. The soft tissue barrier at implants and teeth. Clin Oral
Implants Res. 1991;2(2):81-90.
factors influence Interaction between implant surface
and supra-alveolar CT
• Implant Surface Topography.
• Bioactive Surface Modifications.
• Soft Tissue Seal.
• Implant Design and Emergence
Profile.
factors influence
Interaction between
implant surface and
supra-alveolar CT Implant Surface Topography
• The surface characteristics of dental
implants can influence the behavior of
supra-alveolar CT.
• Rough implant surfaces have shown

to promote a faster and stronger
attachment of CT fibers, leading to
improved soft tissue stability and
enhanced peri-implant esthetics.
Implants Res. 1991;2(2):81-90.
factors influence
Interaction between
implant surface and
supra-alveolar CT Bioactive Surface Modifications
• surface modifications, such as the incorporation of bioactive
substances like hydroxyapatite (HA) or growth factors, can
positively influence the interaction between implant surfaces
and supra-alveolar CT.
• These modifications can promote cellular adhesion,

proliferation, and tissue integration, facilitating a more favorable
soft tissue response.
Implants Res. 1991;2(2):81-90.
factors influence
Interaction between
implant surface and
supra-alveolar CT
Soft Tissue Seal
• The establishment of a stable soft tissue seal around the
implant is crucial to prevent bacterial infiltration and maintain
peri-implant health.
• Implant surfaces that promote epithelial attachment and

discourage epithelial downgrowth can contribute to a more
favourable soft tissue seal and reduced risk of complications.
Lang, N. P., & Berglundh, T.

(2011). Periimplant diseases:
where are we now?—
Consensus of the Seventh
European Workshop on
Periodontology. Journal of
clinical periodontology,
38(S11), 178-181.
factors influence
Interaction between
implant surface and Implant Design and
supra-alveolar CT
Emergence Profile
• The design of the implant, including its shape, contour, and
emergence profile, can influence the formation and
maintenance of the supra-alveolar soft tissues.
• Implant components that replicate natural tooth anatomy and

support the development of harmonious soft tissue contours
contribute to improved esthetics and stability.
Belser, U. C., Grütter, L., Vailati, F., Bornstein, M. M., Weber, H. P., & Buser, D. (2009). Outcome evaluation
of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional,
retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores. Journal
of periodontology, 80(1), 140-151.
Composition of peri-implant mucosa and its role as a barrier
• Epithelial Layer:
• The outermost layer of the peri-implant mucosa.
• composed of stratified squamous epithelium.
• This layer provides a protective barrier against physical, chemical,

and microbial insults from the oral cavity.
• It serves to prevent the invasion of bacteria and other

microorganisms into the peri-implant tissues.
Lindhe, J., Meyle, J., & Group D of European Workshop on Periodontology. (2008). Peri-implant diseases: Consensus Report of the Sixth European
Workshop on Periodontology. Journal of clinical periodontology, 35(8 Suppl), 282-285.
• Connective Tissue Layer:
• Beneath the epithelial layer
• there is a connective tissue layer that consists of fibroblasts, collagen

fibers, blood vessels, and nerves.
• The connective tissue layer provides support and stability to the peri-
implant mucosa.
• It plays a crucial role in maintaining the health and function of the soft
tissues surrounding the implant.
• Junctional Epithelium:
• The junctional epithelium is a specialized epithelial attachment that
connects the peri-implant mucosa to the implant surface.
• It forms a seal around the implant, acting as a barrier against

bacterial penetration and preventing inflammatory cells from
accessing the implant surface.
• The attachment of the junctional epithelium to the implant is not as

strong as that of the natural tooth, which makes it susceptible to
breakdown and inflammation under certain conditions.
Bacterial Barrier:
The intact epithelial layer and the seal provided by the junctional
epithelium act as a physical barrier, preventing the migration of
bacteria from the oral cavity into the peri-implant tissues.
This barrier function is crucial in maintaining the health of the

implant and preventing peri-implant infections.
Berglundh, T., & Lindhe, J. (2003). Dimension of the periimplant mucosa. Biological width revisited. Journal of clinical periodontology, 30(10), 971-
973.
• Mechanical Barrier:
• The peri-implant mucosa acts as a mechanical barrier,

protecting the underlying implant components from physical
trauma or injury caused by masticatory forces or external
factors.
973.
• Immunological Barrier:
• The peri-implant mucosa has an immune defense mechanism

that plays a role in preventing microbial invasion.
• The immune cells present in the connective tissue layer, such as

macrophages and lymphocytes, help to defend against
pathogens and maintain tissue homeostasis.
973.
Histological Differences
Histological Differences
• Differences in the orientation of supracrestal fibres
• known to exhibit a complex three-dimensional arrangement, adapting
to the implant surface and neighboring anatomical structures.
• The specific orientation and arrangement of these fibers can vary
depending on factors such as :
• implant design, placement technique, and individual patient
characteristics.
• Vascular distribution and composition of peri-implant mucosa
• Coronal advancement of the buccal flap is unpredictable

Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla:
anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2004;19 Suppl:43-61.
Differences in the orientation of supracrestal
fibres effect on implant esthetics
• Buccolingual Orientation:
• When supracrestal fibers are oriented predominantly in the
buccolingual direction, they contribute to maintaining the
stability and shape of the interdental papilla.
• Properly aligned and tensioned fibers help create a triangular-
shaped papilla between adjacent implant restorations or natural
teeth, enhancing the esthetic appearance of the implant-
supported restoration.
Kois, J. C. (2008). Predictable single tooth peri-implant esthetics: five diagnostic keys. Compendium of
continuing education in dentistry, 29(4), 1-8; quiz 9.
• Vertical Orientation:
• Supracrestal fibers oriented vertically along
the implant surface can lead to a reduced
interdental papilla and compromised
esthetics.
• Vertical fibers may result in a flat or blunted

appearance of the papilla, which can
negatively affect the overall esthetic
outcome of the implant restoration,
especially in the anterior region.
Hürzeler, M. B., & Weng, D. (1999). A single-tooth implant–a retrospective study. Schweiz Monatsschr
Zahnmed, 109(7), 751-771.
• Diagonal or Oblique Orientation:
• Fibers with a diagonal or oblique orientation can contribute to a more

natural and esthetically pleasing emergence profile.
• These fibers help to create a smooth transition between the implant

restoration and the adjacent soft tissues, enhancing the harmonious
integration of the implant within the natural dentition.
Choquet, V., Hermans, M., Adriaenssens, P., Daelemans, P., & Tarnow, D. P. (2001). Clinical and
radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in
the maxillary anterior region. Journal of periodontology, 72(10), 1364-1371.
Vascular distribution and composition of peri-implant
mucosa
• Supraperiosteal Blood Supply:

• The peri-implant mucosa receives its blood
supply from the supraperiosteal vessels,
which are derived from the surrounding
gingival vasculature.
• supporting their vitality and function.

Vascular distribution and composition of peri-
implant mucosa
• Peri-Implant Circulation:
• After implant placement, angiogenesis occurs, leading to the
formation of new blood vessels around the implant.
• The peri-implant circulation is established through the ingrowth
of blood vessels from the surrounding soft tissues into the peri-
implant mucosa.
• This vascularization is essential for tissue integration and
healing around the implant.
implant mucosa effect
• Soft Tissue Contours:
• The vascularity and composition of the peri-implant mucosa
play a crucial role in achieving natural soft tissue contours
around dental implants.
• Properly distributed blood vessels ensure healthy tissue

appearance and contour, contributing to a harmonious
integration of the implant-supported restoration with the
surrounding soft tissues.
• Pink Aesthetics:
• The vascularization and composition of the
peri-implant mucosa are essential for
achieving pink aesthetics, which refers to
the esthetic appearance of the soft tissues
surrounding the implant.
• Adequate blood supply ensures a healthy,

pink coloration of the gingiva, creating a
pleasing and natural appearance.
• Stability of Interdental Papilla:
• The presence and proper composition of the peri-implant
mucosa are crucial for maintaining the stability and presence of
the interdental papilla.
• The orientation and density of collagen fibers, along with the

appropriate vascularization, contribute to the support and
maintenance of the interdental papilla, enhancing implant
esthetics, especially in the anterior region.
Ridge Defects
• Causes :
• Bone Resorption after Tooth Extraction.
• depending on the extraction technique, healing process, and the
presence or absence of socket preservation techniques.
• Periodontal Disease
• Trauma or Infection
• Ridge Augmentation Techniques
• Hard and soft tissue augmentation techniques can be used to

restore the ridge
Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the
dog. J Clin Periodontol. 2005;32(2):212-218.
Ridge Defects
• Buccopalatal reduction in ridge width implications for implant
treatment planning and esthetic outcomes:
Implant treatment planning
• The reduced ridge width may affect the available space for
implant placement.
• It may require careful evaluation of the available bone width and

consideration of alternative treatment options, such as ridge
augmentation procedures or implant angulation techniques.
Esthetics
• The buccopalatal reduction can impact the
esthetic outcome of implant-supported
restorations, particularly in the anterior
region.
• It may lead to compromised soft tissue

contours, inadequate emergence profile,
and compromised esthetic integration with
the natural dentition.
Socket Preservation Techniques
• Careful extraction of teeth to reduce volumetric alterations of
the extraction socket
• Various socket preservation techniques
• Ridge alteration and the need for hard or soft tissue
augmentation techniques
Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile

Design Integrating Esthetics and Function Essentials in Esthetic
Dentistry. 2016 Jan 1;21-42.
some commonly used socket preservation
techniques for implant esthetics
• Ridge Preservation with Bone Grafting
• Guided Bone Regeneration (GBR)
• Use of Growth Factors
• Socket Seal Technique
• Immediate Implant Placement
Horowitz, R. A., & Holtzclaw, D. (2013). A review on alveolar ridge preservation following tooth extraction.
Journal of Evidence-Based Dental Practice,
Ridge Preservation with Bone Grafting
• Ridge preservation with bone grafting is a widely accepted
technique for preserving the alveolar ridge.
• According to a systematic review and meta-analysis by

Chappuis et al. (2013), ridge preservation with bone grafting
results in a reduction of bone resorption and preservation of
alveolar ridge dimensions, which may improve implant
esthetics.
Chappuis, V., Araújo, M. G., Buser, D., & Bornstein, M. M. (2013). Effectiveness of sinus bone grafting and
simultaneous implant placement in the atrophic posterior maxilla: a systematic review. Journal of Clinical
Periodontology, 40(S14), S106-S127.
Guided Bone Regeneration (GBR)
• GBR is a technique that utilizes a barrier membrane to guide
bone regeneration and prevent soft tissue ingrowth into the graft
site.
• GBR has been shown to be effective in preserving alveolar

ridge dimensions and improving implant esthetics, according to
a systematic review by Suárez-López Del Amo et al. (2016).
Use of Growth Factors
• The use of growth factors, such as platelet-rich
plasma (PRP) and platelet-rich fibrin (PRF), can
enhance bone regeneration and improve implant
esthetics.
• According to a systematic review and meta-analysis

by Mishra et al. (2016), the use of PRP and PRF in
socket preservation results in better soft tissue
healing, reduced bone resorption, and improved
implant esthetics.
Socket Seal Technique
• The socket seal technique aims to preserve the blood clot within
the socket and stabilize it to promote bone formation.
• According to a systematic review by Horowitz et al. (2013), the

socket seal technique can preserve the alveolar ridge
dimensions and improve implant esthetics.
Immediate Implant Placement
• Immediate implant placement is a
technique that involves placing an
implant immediately after tooth
extraction.
• This technique can preserve the

alveolar ridge dimensions and
improve implant esthetics,
according to a systematic review
and meta-analysis by Schropp et
al. (2015).
Soft Tissue Surgical Techniques
• Soft tissue surgical techniques to correct mild defects of 3 mm
or less in the buccopalatal direction
• The subepithelial CT graft as the most widely used and
predictable soft tissue esthetic surgical technique
• The graft is secured to the buccal flap leading to a thicker
gingival biotype, which fills the buccal defect
Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the
dog. J Clin Periodontol. 2005;32(2):212-218.
The Interdental Papilla
• Loss of interdental papilla height can be unsightly in the esthetic

zone.
• Surgical techniques its difficult to deal with the presence of black
triangles due to the difficulty in protecting the blood supply of the
interdental tissues during surgery.
• Soft tissue augmentation techniques have been proposed to build
the papilla with a graft that may be nourished from the underlying
periosteum as well as the overlying mucosa.
• The two most frequently quoted factors influencing the papilla height
are the gingival biotype and the position of the contact point.
Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile Design Integrating Esthetics and Function
Essentials in Esthetic Dentistry. 2016 Jan 1;21-42.
Restorative Techniques
• Altering the contact points to eliminate black triangles
• The distance between the contact point and the interdental

bone crest determines the papilla height.
• Critical measurement for a complete papilla
Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile Design

Integrating Esthetics and Function Essentials in Esthetic Dentistry. 2016 Jan
Distance Between Contact Point and
Interdental Bone Crest
• A distance of up to 5 mm between the contact point and the
interdental bone crest is often reported as the requirement for
achieving a full interdental papilla height.
• When the distance is greater, the chance of soft tissue fill is

reduced.
• The critical measurement for a complete papilla is 6 mm from

the tooth bone crest and 8.5 mm from the implant bone crest to
the contact point.
Soft Tissue Augmentation Techniques
• Soft tissue augmentation techniques involve a partial thickness
semilunar incision at the base of the papilla to build the papilla
with a graft.
• These procedures have been limited to areas where a wide
embrasure space is present, hence allowing coronal
mobilization of the interdental papilla without damaging it.
• Dermal fillers have been used as a promising concept that is

largely experimental at present.
Interimplant Papilla
• The formation of an interimplant papilla is extremely difficult.
• Surgical procedures have been proposed to reconstruct the

interimplant papilla at the time of implant exposure.
• Palacci's method involves rotating a pedicle flap to the mesial side of

the healing abutment using a semilunar bevelled incision.
• Shahidi et al. described a technique without the need for suturing,

involving a U-shaped incision in the soft tissue over the implant.
Factors Affecting Gingival Esthetics
• It is generally easier to achieve a harmonious
gingival contour and emergence profile in patients
with thick gingiva.
• Patients with a thin gingival biotype are more likely

to suffer from recession.
• The esthetic outcome for single tooth implants can

improve significantly during the first year of function.
Long-Term Maintenance of Soft Tissue
Esthetics
• Plaque induced inflammation and trauma to the marginal
tissues from tooth brushing are the two most common causes of
gingival recession.
• Good plaque control regime is important in preventing the
development of recession defects and achieving predictable
long-term results.
• Smoking has a negative impact on periodontal health and can
lead to compromised esthetic results.
• Good gingival esthetics is largely dependent on implant
positioning and the patient's gingival biotype.
• Soft tissue esthetic outcome for single tooth implant-supported
restorations can improve significantly during the first year of
function, including the interdental papillae.
NB
• Successful root coverage is possible with periodontal plastic
surgery techniques for Miller Class I and II defects.
• Stability of the graft during initial healing, degree of coverage of

the graft, and the ability to achieve an adequate blood supply all
influence the success of re-coverage procedures.
• Implant position is of paramount importance in achieving

esthetically pleasing soft tissue architecture.
NB
• Subepithelial CT grafts can be used to improve the peri-implant
soft tissue profile.
• Improvement in esthetics can be expected following the

provision of final restoration, and soft tissue maintenance is
dependent on underlying bone architecture.
White Esthetics:
• focuses on the appearance of the artificial tooth structure, including
the color, shape, size, and alignment.
• To be achieved :
1. Shade Matching
2. Prosthetic Material Selection
3. Prosthetic Design
• mimic the natural teeth in terms of shape, size, and arrangement. Factors
such as tooth proportions, incisal edge position, and tooth anatomy should be
considered
Al-Quran FA, Al-Ghalayini RF, Al-Zu'bi BN. Single-Tooth Replacement: Factors Affecting Different Implant-
Prosthetic Treatment Modalities. BMC Oral Health. 2011;11:34.
Pink Esthetics
• the appearance of the surrounding soft tissue, particularly the
gingiva.
• To be achieved :
1. Gingival Contour.
2. Soft Tissue Thickness.
Prevents the grayish discoloration.
3. Papilla Reconstruction.
4. Peri-implant Mucosal Color.
blend seamlessly with the adjacent natural gingiva.
prosthetic consideration for white and pink
esthetics concept
• Prosthetic Material Selection
• Shade Matching
• Prosthetic Design
• Emergence Profile
• designed to mimic the natural emergence of adjacent teeth. Creating a
gradual and natural-looking emergence.
• Gingival Contour
• Soft Tissue Support
esthetics concept
• Interdental Papilla
• Techniques such as papilla-sparing incisions, connective tissue grafts, or
guided bone regeneration can be utilized to promote papilla reconstruction.
• Prosthetic Contour
• The restoration should have appropriate contours and surface texture to
blend seamlessly with the neighbouring teeth, ensuring a harmonious
appearance.
esthetics concept
• Occlusal Harmony
• The implant-supported
restoration should be
designed to provide stable
and balanced occlusion,
practically lingualized
occlusion, ensuring proper
distribution of forces during
biting and chewing.
esthetics concept
• Interproximal Contact and Embrasure Spaces
• Achieving proper interproximal contact between the implant-
supported restoration and adjacent teeth is important for
esthetics and functional stability.
• The contact points should be positioned correctly to promote

natural emergence profiles and maintain healthy interdental
papillae.
Al-Quran FA, Al-Ghalayini RF, Al-Zu'bi BN. Single-Tooth Replacement:

Factors Affecting Different Implant-Prosthetic Treatment Modalities. BMC Oral
Health. 2011;11:34.
esthetics concept
• Translucency and Opacity
• the desired level of
translucency or opacity to
match the adjacent natural
teeth.
esthetics concept
• Texture and Surface Finish
• Proper surface characterization, including micro-textures and
polishing, can mimic the natural texture of enamel or dentin,
creating a more realistic appearance.
• Soft Tissue Management
• appropriate healing and contouring of the soft tissues, and
management of any potential soft tissue deficiencies or
irregularities.
Al-Nsour MM, Chan HL, Wang HL. Effect of Customized Abutments on Soft Tissue Management and Esthetics
in Implant Dentistry: A Systematic Review. The Journal of Prosthetic Dentistry.
esthetics concept
• Prosthetic Implant Positioning
• Smile Design
• Gingival Margin Placement
• consideration should be given to
factors such as gingival zenith,
symmetry, and alignment with
adjacent teeth.
Kim S, Kim E, Kim Y. The use of digital smile design in aesthetic implant dentistry. Restorative Dentistry &
Endodontics. 2019
esthetics concept
• Customized Implant Abutments
• Long-Term Maintenance
• Proper oral hygiene practices, regular professional
cleanings, and routine follow-up visits.
• Patient Communication and Expectations

Raes F, Cosyn J, De Bruyn H. Clinical, aesthetic, and patient-related outcome of immediately loaded single
implants in the aesthetic zone: a prospective study in patients with a failing dentition. Clinical Implant Dentistry
and Related Research. 2013;
Pink and White Esthetic Score in Implants
• Pink and white esthetic scores provide a systematic approach to assess
implant esthetics
• They assist in treatment planning, communication, and evaluation of

esthetic outcomes
• Clinical judgment and patient preferences should be considered alongside

these scores
• Pink Esthetics: Refers to the appearance of the surrounding soft tissues,

including the gingiva and interdental papilla.
• White Esthetics: Refers to the esthetic appearance of the implant-

supported restoration.
Furhauser R, et al. Evaluation of Soft Tissue around Single-Tooth Implants Using a Pink Esthetic Score: A Cross-
Sectional Study. Journal of Periodontology. 2005; 76(8): 1246-1251.
Pink Esthetic Score (PES)
• PES is a quantitative scoring system used to assess pink
esthetics around dental implants.
• Developed by Furhauser et al. in 2005.
• Evaluates parameters such as papilla fill, contour, and soft

tissue color.
• Scored on a scale from 0 to 2 for each parameter, with a total

maximum score of 10.
Furhauser R, et al. Evaluation of Soft Tissue around Single-Tooth Implants Using a Pink Esthetic Score: A Cross-
Sectional Study. Journal of Periodontology. 2005; 76(8): 1246-1251.
Pink Esthetic Score (PES)
White Esthetic Score (WES)
• WES is a quantitative scoring system used to assess white
esthetics of implant-supported restorations.
• Developed by Belser et al. in 2009.
• Evaluates parameters such as tooth shape, color, surface

texture, and incisal edge position.
• Scored on a scale from 0 to 4 for each parameter, with a total

maximum score of 20.
Belser UC, et al. The Pink Esthetic Score: A New Visual Index for Assessment of Soft Tissue Esthetics in Implant
Dentistry. The International Journal of Periodontics & Restorative Dentistry. 2009; 29(6): 555-561.
Importance of Pink and White Esthetic Scores
• Pink and white esthetic scores help clinicians objectively
evaluate and communicate esthetic outcomes.
• Aid in treatment planning and decision-making processes.
• Provide a standardized approach for assessing and comparing

esthetic results across different cases and clinicians.
Clinical Application and Limitations
• Pink and white esthetic scores are valuable tools, but they have
limitations.
• Subjective interpretation of scores may vary among clinicians.
• Scores may not capture all aspects of esthetics or patient

preferences.
• Additional factors such as patient satisfaction and perception

should also be considered.
Thank You

17-IMPLANT Esthetics

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

17-IMPLANT Esthetics

Uploaded by

Copyright:

Available Formats

Implant Ethetics

Hassan Hussein Hassan ElHusseiny

Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile

• Following tooth extraction, socket preservation

• This helps to preserve the soft tissue architecture,

• Soft tissue grafting procedures, such as connective tissue grafts

• These techniques help to create a harmonious transition

• This involves the use of bone grafts and soft tissue

• Block grafts for severe cases.

• Guided bone regeneration for mild to moderate defects.

• Free gingival onlay grafts for height increase.

• Subepithelial CT grafts for ridge width increase.

• Limited use in implant dentistry for mild horizontal defects.

• Well-designed provisional restorations can promote the

Kokich, V. G., & Kokich, V. O. (1997). Esthetics of

• Implant position should consider the contour of adjacent natural

• Angles between 20° proclined and 10° retroclined are

• Minor errors can be corrected with angled abutments.

• Emergence profile depends on crown size, implant diameter,

• Implant margin should be placed 3-4 mm apical to the soft

Levine JB, Finkel S. Esthetic diagnosis a three-

• Interaction between implant surface and supra-alveolar CT.

• Composition of peri-implant mucosa and its role as a

• Rough implant surfaces have shown

• These modifications can promote cellular adhesion,

• Implant surfaces that promote epithelial attachment and

Lang, N. P., & Berglundh, T.

• Implant components that replicate natural tooth anatomy and

• composed of stratified squamous epithelium.

• This layer provides a protective barrier against physical, chemical,

• It serves to prevent the invasion of bacteria and other

• there is a connective tissue layer that consists of fibroblasts, collagen

• It forms a seal around the implant, acting as a barrier against

• The attachment of the junctional epithelium to the implant is not as

This barrier function is crucial in maintaining the health of the

• The peri-implant mucosa acts as a mechanical barrier,

• The peri-implant mucosa has an immune defense mechanism

• The immune cells present in the connective tissue layer, such as

• Vascular distribution and composition of peri-implant mucosa

• Coronal advancement of the buccal flap is unpredictable

• Vertical fibers may result in a flat or blunted

• Fibers with a diagonal or oblique orientation can contribute to a more

• These fibers help to create a smooth transition between the implant

• Supraperiosteal Blood Supply:

• supporting their vitality and function.

• Properly distributed blood vessels ensure healthy tissue

• Adequate blood supply ensures a healthy,

• The orientation and density of collagen fibers, along with the

• Hard and soft tissue augmentation techniques can be used to

• It may require careful evaluation of the available bone width and

• It may lead to compromised soft tissue

Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile

• According to a systematic review and meta-analysis by

• GBR has been shown to be effective in preserving alveolar

• According to a systematic review and meta-analysis

• According to a systematic review by Horowitz et al. (2013), the

• This technique can preserve the

• Loss of interdental papilla height can be unsightly in the esthetic

• The distance between the contact point and the interdental

• Critical measurement for a complete papilla

Levine JB, Finkel S. Esthetic diagnosis a three-step analysis. Smile Design

• When the distance is greater, the chance of soft tissue fill is