Influence of anatomical changes in implant-supported crowns of maxillary central incisors on the functional state

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Abstract
BACKGROUND: Immediate implant placement and immediate loading after maxillary central incisor extraction are of great importance. Implant placement with immediate loading is the most preferred method of treatment in the long term. The anatomical constrictions of the maxilla make implant placement difficult. To achieve primary stability and make a screw-retained crown, dental surgeons are forced to fix the implant placing it toward the palatal wall. When the implant is placed this way, the crown will be bulkier than the one of the extracted tooth. This change in anatomy can lead to patient discomfort and some parafunctions (in speech, chewing, etc.). AIM: To assess the potential discomfort in patients with changes in the crown anatomy of maxillary central incisors after implant-supported prosthetics. METHODS: Fifty students (25 men and 25 women) underwent intraoral scanning with the 3Shape scanner. A possible increase in the crown volume was simulated in ExoCAD at a rate of an implant + titanium base + layer of structural material with zirconium dioxide as an example, on average equal to 34 mm. Onlays imitating the increased crown volume were milled and fixed in the oral cavity of the participants on tooth 1.1, and further examinations were conducted. RESULTS: The examination revealed that the crown anatomy change brought some discomforts in most of the respondents whose speech and eating were affected. CONCLUSION: The results reveal that a change in the anatomical shape of the crown during implant-supported prosthetics can affect vital functions and cause discomfort. More attention is needed to implant placement planning, taking into account further prosthetics in the esthetic area. Therefore, the use of angulated implants is encouraged.

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