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page 24DTß out the osteotomies. Following completion of the prepared implant sites, visual and tactile inspection of the internal bony walls was performed to ensure the ab- sence of any fenestration or dehiscence at the cervical area. Two 2.5mm-diameter implants (MS implant, Os- stem) were then placed in the ideal 3-D position and torqued to 25Ncm with a man- ual torque wrench. The superi- or margin of the transmucosal portion was positioned 2 mm apical to the soft tissue mar- gin (Figs. 6 & 7). Immediately following implant placement, provisional restorations were fabricated at chairside using prefabricated temporary abut- ments and acrylic resin. The provisional restora- tions were snapped into posi- tion using the friction-fit tem- porary abutments, eliminating the use of cement (Figs. 8 & 9). This could remove the risk of cement being forced into the gap between the implant fix- ture and soft tissue. The pro- visional restorations had no centric or eccentric occlusal contacts. The patient was in- structed to avoid any function of the implant for eight weeks. After a healing phase of two months, a final impression was produced using friction-fit im- pression caps (Figs. 10 & 11). Definitive restorations were then fabricated on the working cast and adjusted to have slight occlusal contacts in centric oc- clusion and excursive move- ments (Figs. 12–14). The clinical re-evaluation demonstrated a minimal gin- gival change around the pros- thesis, and a stable horizontal bone level was observed ra- diographically at the 13-month follow-up (Figs. 15 & 16). Case II A 58-year-old male patient pre- sented with severe mobility and peri-apical lesions on teeth #23 and 24 (Fig. 17). A provi- sional restoration was fabricat- ed and bonded to the adjacent natural teeth immediately fol- lowing extraction (Fig. 18). The provisional restoration was left undisturbed for 11 weeks and the interdental papillae were preserved with ovate pontics (Figs. 19 & 20). The interdental distance measured between teeth #22 and 25 was 8mm, and two 2.5mm-diameter implants were placed in position. The superi- or margin of the transmucosal portion was positioned sub- gingivally, and the height of the abutments was reduced to en- sure adequate incisal clearance (Fig. 21). Owing to the limited interdental space, the impres- sion caps were modified (Fig. 22). An indexing jig was used to avoid any undue stress ap- plied to implant fixtures during the impression procedure (Fig. 23). An altered cast was made, and a definitive prosthesis was fabricated. The clinical and radiographic evaluation at 11 months demonstrated a good aesthetic result with no sig- nificant peri-implant bone loss (Fig. 24). Conclusion Based on the clinical cases presented in this article, the utilisation of one-piece MDIs appears to be a good treatment option for replacing missing mandibular incisors. Consid- ering the simplicity, ease of implant placement and imme- diate provisionalisation, this treatment offers a new option for patient care. DT About the author Dr Chonghwa Kim specialises in prosthodontics and implantology. He works in a private practice in down- town Seoul, Korea. He graduated from the University of Michigan School of Dentistry in 1997 and completed prostho dontic training at the Uni- versity of Minne- sota. Dr Kim is Co-director of the Glo- bal Academy of Osseointegration and serves as a Director of international relations for the Korean Academy of Esthetic Dentistry. He can be contacted at kimchonghwa@hotmail.com. Fig. 18 Resin-bonded provisional restoration after extraction of teeth #23 and 24 ‘Considering the simplicity, ease of implant placement and immediate pro- visionalisation, this treatment offers a new option for pa- tient care’ Fig. 19 Eleven weeks post-extraction Fig. 20 Papilla preservation with ovate pontics Fig. 21 Eight weeks post-implant placement Fig. 22 Modified impression caps Fig. 23 Indexing jig Fig. 24 Final prosthesis Fig. 26 Peri-apical X-ray Fig. 25 Eleven-month follow-up Fig 18 Fig 19 Fig 20 Fig 21 Fig 22 Fig 23 Fig 24 Fig 26 Fig 25 September 12-18, 201126 Clinical United Kingdom Edition