In 2006, I received a copy of the ITI Treatment Guide Volume 1: Implant therapy in the aesthetic zone (TGV1), free of charge as a member of the ITI. I was not particularly aware of the fact that I would be receiving this book and didn’t realise how it would change my practising life. This became a resource that I would use in years to come and as I flick through the book now it is a well-used old friend in implant dentistry. This book has become my guide to the treatment of patients with implants in the aesthetic zone and how to achieve predictable results in these cases and to explain to patients when they cannot be achieved. It has enabled me to discuss with patients issues such as risks that the patients bring with them to the treatment and taught me not to beat myself up when I cannot achieve an exceptional aesthetic result. This ability to assess patients appropriately prior to treatment has removed much of the stress of my implant practice in the aesthetic zone and allowed me to talk honestly and openly to patients about what kind of results I can actually achieve. Further to this, in patients who have ideal conditions, I can explain how I know we can provide an exceptional result and show them examples of the results we have already provided.
The TGV1 begins (as all the treatment guides do) with the statements from the consensus document recommending clinical procedures regarding aesthetics in implant dentistry. It discusses treatment planning of patients in the aesthetic zone and uses wonderful schematics to demonstrate the points raised. The clinical photography is simply superb and the description of surgical procedures in aesthetic cases is the best I have ever seen. Following the surgical section, the restorative elements of treatment of patients in the aesthetic zone is simply second to none. This is the area that particularly changed my practising career as I am an oral surgeon with limited expertise in implant restorative care and this allowed me to provide some wonderful results in cases where aesthetics were of high demand. In particular, the description of the custom impression technique allowed me to provide results as shown. For those who are unaware of the technique, it involves the use of a provisional or adjustable crown following exposure of the implant. This takes for granted the fact that the implant will have been placed using an appropriate aesthetic protocol and achieving primary closure at all times. Once the provisional, adjustable crown is in place it is possible to leave the area to mature and to adjust the crown appropriately to achieve the best possible gingival aesthetics. Once both the patient and clinician are satisfied that the result is optimised, it is possible to take a custom impression of the provisional restoration and to send this to the laboratory to allow the technician to fabricate a crown with the ideal emergence profile to retain excellent gingival aesthetics. Following a thorough description of how this can be achieved in ideal cases, there is an excellent chapter on aesthetic complications and their causes, which explains why optimal aesthetics are not achieved in many cases.