Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76% at the time and 35 to 87% after extraction). From 72.5% patients who expressed intention of immediate replacement of edentulous spaces, only 8.1% had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.

When dealing with peri-implant tissue manipulation in aesthetic areas, there is always great expectation regarding the result. Depending on the clinical situation, different solutions can be used. This report presents an example of an approach that may favor the results of oral rehabilitation with dental implants. After implant installation in the region corresponding to teeth 15 and 16, the patient complained of a sinking in the implanted region, causing an aesthetic defect. Grafting of connective tissue was performed to gain volume in the vestibular region, thus seeking harmony with the adjacent tissues, this technique was associated with the fixed provisional crowns on the implants, to create an emergency profile and gingival contour close to the natural. The approach was chosen based mainly on the volume and quality of the peri-implant tissue. For good predictability, factors such as soft tissue and hard peri-implant quality must be carefully evaluated. Coupled with a good aesthetic and functional prosthetic rehabilitation, will guide the way to a satisfactory result.