Int J Stomatol ›› 2019, Vol. 46 ›› Issue (6): 621-630.doi: 10.7518/gjkq.2019099

• Expert Forum •     Next Articles

Digital planning strategies in aesthetic areas

Cai Xiaoxiao()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2019-08-01 Revised:2019-09-10 Online:2019-11-01 Published:2019-11-14
  • Contact: Xiaoxiao Cai
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81471803);This study was supported by National Natural Science Foundation of China(81771125)


Implant treatment in aesthetic zones has always been difficult in implant therapy. With the development of digital technology, the treatment in aesthetic zones acquires new connotation. This article expounds the implant treatment protocol in aesthetic zones in the digital era from the aspects of pre-implant evaluation and design, digital implant surgery, and digital prosthesis. Digital smile design (DSD) achieves the ideal position and shape of the prosthesis by referring to the patient’s face shape and tooth shape. Surgical guide and navigation system ensure the optimal and most rational implant position. The digital aided bone augmentation makes the augmentation effect precise and controllable. Digital aided prosthesis not only provides comfortable experience for patients, but also brings more efficient digital workflow for doctors. In conclusion, this paper elaborates the implant therapy mode of aesthetic area in the digital era, in order to provide reference for clinicians to carry out implant therapy in aesthetic zones.

Key words: aesthetics zone implant, digital workflow, precision implanting, treatment protocol

CLC Number: 

  • R783.4


Fig 1

DSD and diagnostic wax-up"

Fig 2

Application of titanium mesh for severe bone defects in the esthetic zone"

Fig 3

Digital procedure for bone augmentation with titanium mesh"

Fig 4

Application of digital impression"

[1] Sonick M, Hwang D, Dworkin J . Implants in the aesthetic zone: clinical guidelines[J]. Dent Today, 2017,36(1):91.
[2] 宿玉成 . 口腔种植学[M]. 2版. 北京: 人民卫生出版社, 2014: 242.
Su YC. Implant dentistry[M]. 2nd Ed. Beijing: People’s Medical Publishing House, 2014: 242.
[3] Joda T, Ferrari M, Gallucci GO , et al. Digital te-chnology in fixed implant prosthodontics[J]. Perio-dontol 2000, 2017,73(1):178-192.
[4] Dawson A, Chen S, Buser D , et al. The SAC classi-fication in implant dentistry[M]. Berlin: Quintes-sence Publishing, 2009: 14-23.
[5] Meereis CTW, de Souza GBF, Albino LGB , et al. Digital smile design for computer-assisted esthetic rehabilitation: two-year follow-up[J]. Oper Dent, 2016,41(1):E13-E22.
[6] Coachman C, Calamita MA, Sesma N . Dynamic documentation of the smile and the 2D/3D digital smile design process[J]. Int J Periodontics Resto-rative Dent, 2017,37(2):183-193.
[7] 余挺, 杨希, 赵莉 , 等. 中国汉族成年人的上前牙临床牙冠长度及宽长比分析[J]. 口腔医学研究, 2018,34(9):1003-1006.
Yu T, Yang X, Zhao L , et al. Length and width-to-length ratio of clinical crown of Chinese Han adults in Wuhan[J]. J Oral Sci Res, 2018,34(9):1003-1006.
[8] Stanley M, Paz AG, Miguel I , et al. Fully digital workflow, integrating dental scan, smile design and CAD-CAM: case report[J]. BMC Oral Health, 2018,18(1):134.
[9] Cervino G, Fiorillo L, Arzukanyan AV , et al. Dental restorative digital workflow: digital smile design from aesthetic to function[J]. Dent J (Basel), 2019,7(2):E30.
[10] Harris BT, Montero D, Grant GT , et al. Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: a clinical report[J]. J Prosthet Dent, 2017,117(2):197-204.
[11] Lin WS, Harris BT, Phasuk K , et al. Integrating a facial scan, virtual smile design, and 3D virtual patient for treatment with CAD-CAM ceramic veneers: a clinical report[J]. J Prosthet Dent, 2018,119(2):200-205.
[12] Tahmaseb A, Wismeijer D, Coucke W , et al. Computer technology applications in surgical implant dentistry: a systematic review[J]. Int J Oral Maxillofac Implants, 2014,29(Suppl):25-42.
[13] Buser D, Martin W, Belser UC . Optimizing esthetics for implant restorations in the anterior maxilla: ana-tomic and surgical considerations[J]. Int J Oral Ma-xillofac Implants, 2004,19(Suppl):43-61.
[14] Colombo M, Mangano C, Mijiritsky E , et al. Clinical applications and effectiveness of guided implant surgery: a critical review based on randomized con-trolled trials[J]. BMC Oral Health, 2017,17(1):150.
[15] Turbush SK, Turkyilmaz I . Accuracy of three dif-ferent types of stereolithographic surgical guide in implant placement: an in vitro study[J]. J Prosthet Dent, 2012,108(3):181-188.
[16] Ozan O, Turkyilmaz I, Ersoy AE , et al. Clinical accuracy of 3 different types of computed tomo-graphy-derived stereolithographic surgical guides in implant placement[J]. J Oral Maxillofac Surg, 2009,67(2):394-401.
[17] Sato D, Kanazawa M, Kim YK , et al. Immediate loading of two freestanding implants placed by computer-guided flapless surgery supporting a man-dibular overdenture with magnetic attachments[J]. J Prosthodont Res, 2016,60(1):54-62.
[18] D’haese J, Ackhurst J, Wismeijer D , et al. Current state of the art of computer-guided implant surgery[J]. Periodontol 2000, 2017,73(1):121-133.
[19] 贾胜男, 罗佳, 林野 . 计算机辅助导航技术在口腔种植手术中的应用[J]. 中华口腔医学杂志, 2014,49(6):379-382.
Jia SN, Luo J, Lin Y . Application of computer aided navigation technology in oral implant surgery[J]. Chin J Stomotol, 2014,49(6):379-382.
[20] Jung RE, Schneider D, Ganeles J , et al. Computer technology applications in surgical implant dentistry: a systematic review[J]. Int J Oral Maxillofac Implants, 2009,24(Suppl):92-109.
[21] Wu YQ, Wang F, Fan SC , et al. Robotics in dental implantology[J]. Oral Maxillofac Surg Clin North Am, 2019,31(3):513-518.
[22] 吴秦 . 口腔种植机器人空间映射装置的研发及其应用研究[D]. 西安: 第四军医大学, 2016.
Wu Q . Research on the creation and application of the spatial mapping devices of the dental implant robot system[D]. Xi’an: The Fourth Military Medical University, 2016.
[23] 谢瑞 . 口腔种植机器人系统精度的相关研究[D]. 西安: 第四军医大学, 2016.
Xie R . The study accuracy of the Dental Implanto-logy Robotic System[D]. Xi’an: The Fourth Military Medical University, 2016.
[24] Chiapasco M, Casentini P . Horizontal bone-augmen-tation procedures in implant dentistry: prosthetically guided regeneration[J]. Periodontol 2000, 2018,77(1):213-240.
[25] Chiapasco M, Casentini P, Zaniboni M . Bone aug-mentation procedures in implant dentistry[J]. Int J Oral Maxillofac Implants, 2009,24(Suppl):237-259.
[26] Nyman S, Karring T, Lindhe J , et al. Healing following implantation of periodontitis-affected roots into gingival connective tissue[J]. J Clin Periodontol, 1980,7(5):394-401.
[27] Briguglio F, Falcomatà D, Marconcini S , et al. The use of titanium mesh in guided bone regeneration: a systematic review[J]. Int J Dent, 2019,2019:9065423.
[28] Sumida T, Otawa N, Kamata YU , et al. Custom-made titanium devices as membranes for bone augmen-tation in implant treatment: clinical application and the comparison with conventional titanium mesh[J]. J Craniomaxillofac Surg, 2015,43(10):2183-2188.
[29] Al-Ardah AJ, Alqahtani N, AlHelal A, et al. Using virtual ridge augmentation and 3-dimensional prin-ting to fabricate a titanium mesh positioning device: a novel technique letter[J]. J Oral Implantol, 2018,44(4):293-299.
[30] Mounir M, Shalash M, Mounir S , et al. Assessment of three dimensional bone augmentation of severely atrophied maxillary alveolar ridges using prebent titanium mesh vs customized poly-ether-ether-ketone (PEEK) mesh: a randomized clinical trial[J]. Clin Im-plant Dent Relat Res, 2019. DOI: 10.1111/cid.12748.
[31] Ciocca L, Fantini M, De Crescenzio F , et al. Direct metal laser sintering (DMLS) of a customized titanium mesh for prosthetically guided bone re-generation of atrophic maxillary arches[J]. Med Biol Eng Comput, 2011,49(11):1347-1352.
[32] Ciocca L, Ragazzini S, Fantini M , et al. Work flow for the prosthetic rehabilitation of atrophic patients with a minimal-intervention CAD/CAM approach[J]. J Prosthet Dent, 2015,114(1):22-26.
[33] Sagheb K, Schiegnitz E, Moergel M , et al. Clinical outcome of alveolar ridge augmentation with in-dividualized CAD-CAM-produced titanium mesh[J]. Int J Implant Dent, 2017,3(1):36.
[34] Jacotti M, Barausse C, Felice P . Posterior atrophic mandible rehabilitation with onlay allograft created with CAD-CAM procedure: a case report[J]. Implant Dent, 2014,23(1):22-28.
[35] De Stavola L, Fincato A, Albiero AM . A computer-guided bone block harvesting procedure: a proof-of-principle case report and technical notes[J]. Int J Oral Maxillofac Implants, 2015,30(6):1409-1413.
[36] Ciocca L, Lizio G, Baldissara P , et al. Prosthetically CAD-CAM-guided bone augmentation of atrophic jaws using customized titanium mesh: preliminary results of an open prospective study[J]. J Oral Im-plantol, 2018,44(2):131-137.
[37] Javaheri D. Achieving anterior aesthetics in a full-arch implant case[J]. Dent Today, 2016, 35(1): 118, 120-121.
[38] Santosa RE . Provisional restoration options in implant dentistry[J]. Aust Dent J, 2007,52(3):234-242, 254.
[39] Heymann HO . The Carolina bridge: a novel interim all-porcelain bonded prosjournal[J]. J Esthet Restor Dent, 2006,18(2):81-92.
[40] Chu SJ, Salama MA, Garber DA , et al. Flapless postextraction socket implant placement, part 2: the effects of bone grafting and provisional restoration on peri-implant soft tissue height and thickness—a retrospective study[J]. Int J Periodontics Restorative Dent, 2015,35(6):803-809.
[41] Tarnow D, Chu S, Salama M , et al. Flapless post-extraction socket implant placement in the esthetic zone: part 1. the effect of bone grafting and/or pro-visional restoration on facial-palatal ridge dimen-sional change: a retrospective cohort study[J]. Int J Periodontics Restorative Dent, 2014,34(3):323-331.
[42] Saito H, Chu SJ, Reynolds MA , et al. Provisional restorations used in immediate implant placement provide a platform to promote peri-implant soft tissue healing: a pilot study[J]. Int J Periodontics Restorative Dent, 2016,36(1):47-52.
[43] Liu XQ, Tan Y, Liu JZ , et al. A digital technique for fabricating implant-supported interim restorations in the esthetic zone[J]. J Prosthet Dent, 2018,119(4):540-544.
[44] Vafiadis D, Goldstein G, Garber D , et al. Immediate implant placement of a single central incisor using a CAD/CAM crown-root form technique: provisional to final restoration[J]. J Esthet Restor Dent, 2017,29(1):13-21.
[45] Joda T, Ferrari M, Braegger U . A digital approach for one-step formation of the supra-implant emer-gence profile with an individualized CAD/CAM healing abutment[J]. J Prosthodont Res, 2016,60(3):220-223.
[46] Anssari Moin D, Hassan B, Wismeijer D . A novel approach for custom three-dimensional printing of a zirconia root analogue implant by digital light pro-cessing[J]. Clin Oral Implants Res, 2017,28(6):668-670.
[47] Chappuis V, Martin W. ITI treatment guide (volume 10)[M]. Berlin: Quintessence Publishing, 2017: 145.
[48] Fradeani M, Barducci G. 口腔固定修复中的美学重建(第2卷)[M]. 王新知, 译. 北京: 人民军医出版社, 2009: 253.
Fradeani M, Barducci G. Esthetic rehabilitation in fixed prosthodontics (volume 2)[M]. Wang XZ, Translate. Beijing: People’s Military Medical Publishing House, 2009: 253.
[49] Yilmaz B . CAD-CAM high-density polymer im-plant-supported fixed diagnostic prostheses[J]. J Prosthet Dent, 2018,119(5):688-692.
[50] 谭震 . 口腔种植关键技术实战图解[M]. 北京: 人民卫生出版社, 2014: 314.
Tan Z. Color atlas of the key techniques in implant dentistry[M]. Beijing: People’s Medical Publishing House, 2014: 314.
[51] Fasbinder DJ . Digital dentistry: innovation for re-storative treatment[J]. Compend Contin Educ Dent, 2010,31(Spec No 4):2-12.
[52] Yuzbasioglu E, Kurt H, Turunc R , et al. Comparison of digital and conventional impression techniques: evaluation of patients’ perception, treatment comfort, effectiveness and clinical outcomes[J]. BMC Oral Health, 2014,14:10.
[53] Joda T, Brägger U . Patient-centered outcomes com-paring digital and conventional implant impression procedures: a randomized crossover trial[J]. Clin Oral Implants Res, 2016,27(12):e185-e189.
[54] Monaco C, Ragazzini N, Scheda L , et al. A fully digital approach to replicate functional and aesthetic parameters in implant-supported full-arch rehabi-litation[J]. J Prosthodont Res, 2018,62(3):383-385.
[55] Monaco C, Evangelisti E, Scotti R , et al. A fully digital approach to replicate peri-implant soft tissue contours and emergence profile in the esthetic zone[J]. Clin Oral Implants Res, 2016,27(12):1511-1514.
[56] Wasiluk G, Chomik E, Gehrke P , et al. Incidence of undetected cement on CAD/CAM monolithic zirconia crowns and customized CAD/CAM implant abut-ments. A prospective case series[J]. Clin Oral Implants Res, 2017,28(7):774-778.
[57] Pietruski JK, Skurska A, Bernaczyk A , et al. Evalua-tion of concordance between CAD/CAM and clinical positions of abutment shoulder against mucosal margin: an observational study[J]. BMC Oral Health, 2018,18(1):73.
[58] Nascimento CD, Pita MS, Fernandes FHNC , et al. Bacterial adhesion on the titanium and zirconia abutment surfaces[J]. Clin Oral Implants Res, 2014,25(3):337-343.
[59] Pabst AM, Walter C, Bell A , et al. Influence of CAD/CAM zirconia for implant-abutment manufacturing on gingival fibroblasts and oral keratinocytes[J]. Clin Oral Investig, 2016,20(5):1101-1108.
[1] Luo Qiyue,Liu Yeyu,Luo Yilin,Man Yi.. Centric relation centered, facial esthetically and prosthetically driven digital workflow for edentulism implant rehabilitation: a clinical report [J]. Int J Stomatol, 2022, 49(4): 426-431.
[2] Xue Du,Fang Qu,Weicai Liu. Establishment of a three-dimensional virtual dental patient and its application in esthetic restoration [J]. Inter J Stomatol, 2018, 45(6): 695-702.
[3] Man Yi, Wu Qingqing, Gong Ting, Gong Ping. A new surgical and prosthetic protocol for dental implant treatment in the aesthetic area [J]. Inter J Stomatol, 2015, 42(4): 373-383.
Full text



[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[9] . [J]. Foreign Med Sci: Stomatol, 2004, 31(02): 126 -128 .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .