Clinical DENTAL TRIBUNE | September 20118A Two cases The first case will deal with the anterior segment of soft-tissue asymmetry cased by trauma. The ERA implant is used primarily to provide support for dentures in areas where the remaining bone will not support conventional implants without significant bone grafting and other invasive proce- dures. It accomplishes this by reduc- ing the size but not the material composition of the conventional implants while adding an aggres- sive thread design that provides a self-tapping feature to the implant. The second case deals with a patient with a Type III lip, sig- nificant bone loss before implant placement and presents with an esthetic challenge. When doing a diagnostic work- up, if we line up each challenge that is an obstacle in our quest to provide both a functional and an esthetic end result, each solution we find brings us much closer to a predictable overall result. This article will address the challenge of soft-tissue asymme- try in the cosmetic zone with a new approach to a very challenging problem that, until recently, had few predictable solutions. The area extends from molar to molar in the maxillae in patients with Type II and III lips. These are patients that show some soft tissue when smiling (Type II lip) to those that show significant soft tissue (Type III lip). Case No. 1 The first patient presented with a bridge that had been placed after trauma to the anterior maxillae. Although one hard-tissue and two soft-tissue grafts had been performed and the new bridge constructed, the defect was still unacceptable to the patient. The hard- and soft-tissue defect was 6 mm inferior and 4 mm palatal to where it was necessary to create ideal tissue symmetry (Fig. 1). Utilizing the ERA over-denture implant to create soft-tissue symmetry in the esthetic zone By Joe Carrick, DDS AD Fig. 1: Case No. 1 — The patient already had one block bone graft and two soft-tissue grafts that pro- duced this result. (Photos/Provided by Dr. Joe Carrick) Fig. 2: We made a resin bridge from the upper left cuspid to the upper right central incisor, replacing the left lateral and central incisor.