cosmetic dentistry_ beauty & science International

22 I I industry report _ single-tooth implants cosmeticdentistry 3_2011 mately 1 to 1.5 mm. As the length of the remain- ing root was insufficient for a combined en- dodontic–prosthetic restoration and the crown margin was to be positioned sub-gingivally to provide an optimal aesthetic result, we decided to extract the remaining part of the root and to replace it with a XiVE S plus implant (DENTSPLY Friadent). The periodontal fibres in the root area were loosened with a scalpel. The periodontal gap was extended with a periotome and the sub- crestal fibres separated. This was the most atraumatic course of tooth extraction. Then, the extraction alveolar was carefully debrided to remove any remaining granulation tissue completely. To avoid damaging the labial bone lamella, no force was exerted in bucco-palatal direction during root extraction. The soft tissue remained undamaged by avoiding a vertical incision. Using palatal mucosa as a free gingival graft, we ensured primary healing in the region of the extraction alveolar. This was previously measured with a periodontal probe, the corresponding trimmed graft placed over the alveolar cavity and stabilised with sutures (Fig. 3). To support the mesial and distal papillae and to condition the tissue, a temporary crown was constructed from compositematerialandfixedtotheneighbouring teeth as an ovate pontic (Fig. 4). Implant place- ment was carried out six weeks later. Immediate implantplacementaftertoothextractionisusual, but in this case controlled bone regeneration was also required, which made implant placement directly after extraction of the remaining root part inadvisable. A para-crestal incision some 2 to 3 mm palatal to the alveolar ridge was carried out under local anaesthetic, and a mucoperiosteal flap was pre- paredusingaperiostealelevator.Theflapreached buccally to the muco-gingival junction. This way, the alveolar ridge could be exposed. The bone was cleared of connective tissue. The implant position was determined using a locator. In order to avoid perforation of the labial bone safely, the implant was not to be inserted directly into the alveolar socket but shifted slightly in a palatal direction. To permit insertion of the implant within the aesthetic window, we determined the ideal bucco-palatal alignment using surgical suture materials fixed to the neighbouring teeth (Fig. 5). Fig. 9_The X-ray after six months demonstrates good bone regeneration. Fig. 10_The clinical situation after removing interim treatment. Fig. 11_Uncovery of the implant with a scalpel. Fig. 12_The TempBase Abutment is reinserted and fitted with a TempBase Cap as temporary treatment. Fig. 12Fig. 11 Fig. 10Fig. 9