
Mid-Facial Recession Poses Challenges in Implant Restorations
Mid-facial recession is a frequent complication in anterior implant therapy, with advanced cases observed in up to 64% of immediate placements. Effective treatment demands careful assessment of implant positioning, periodontal health, and component availability, especially in the esthetic zone.
Single implant restorations have become an integral part of the contemporary dental practice. With the increasing number of implants placed over the past decade, the incidence of implant complications has also increased. One of the most common complications associated with a maxillary anterior dental implant is the development of a mid-facial recession.1,2
A systematic review showed that advanced mid-facial recessions (≥ 1.0 mm) were seen in up to 64% of immediate implant therapy cases.3 The midfacial recession associated with implant restorations seems to be a common sequela of the implant positioning into the alveolus.4 The anatomy of the premaxilla commonly includes a concavity on the facial aspect and implants are usually placed with an orientation to avoid an apical perforation of the ridge.5
Consequences of a poorly angulated implant in the esthetic zone include the unwanted over-contouring of the abutment and the crown that puts pressure on the facial tissue, leading to gingival recession.6 The treatment approach to correct these defects hinges on the decision of whether to save or remove the implant; this decision is especially critical if the implant is located in the esthetic zone. Treatment also must consider the three-dimensional (3D) implant position, periodontal condition of the implant, and availability of the implant component.
References
- Cheng Q, Su YY, Wang X, Chen S. Clinical outcomes following immediate loading of single-tooth implants in the esthetic zone: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2020;35:167-177.
- Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla — a systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):186-215.
- Cosyn J, Hooghe N, De Bruyn H. A systematic review on the frequency of advanced recession following single immediate implant treatment. J Clin Periodontol. 2012;39:582-589.
- Cosyn J, Sabzevar MM, De Bruyn H. Predictors of inter-proximal and midfacial recession following single implant treatment in the anterior maxilla: a multivariate analysis. J Clin Periodontol. 2012;39:895-903.
- Hwang KG, Park CJ. Ideal implant positioning in an anterior maxillary extraction socket by creating an apico-palatal guiding slot: a technical note. Int J Oral Maxillofac Implants. 2008;23:121-122.
- Su H, Gonzalez-Martin O, Weisgold A, Lee E. Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int J Periodontics Restorative Dent. 2010;30:335-343.
This information originally appeared in Boeriu S, Hottel TL, Chirla C, Chirla P. Recession defects on a maxillary single tooth implant. Decisions in Dentistry. March 2024;10(2):16-19.