implants - internationalmagazine of oral implantology

user report _ revision I I 37implants4_2011 Fig. 22_The gap requiring restoration. Fig. 23_Fired ceramic crown. Fig. 24_Inserted abutment. Fig. 25_Crown in situ. Fig. 26_Oral situation. the open tray technique (Fig. 16). The model made from type-IV gypsum with a gingival mask permits the production of an aesthetically high-quality crown(Fig.17).Anangledabutmentwasselectedto correcttheangulationandadaptedtofollowtheline of the gingiva (Fig. 18). The internal hexagon con- nection prevents rotation (Fig. 19). A cementable metal ceramic crown, based on an alloy with a high gold content that can be fired, completes the restoration (Fig. 20). The diastema at the front was left in accordance with the patient's wishes, as was theslightlyrotatedandparadontallywornno.2(Fig. 21). The otherwise triangular crown of the no.1 was roundedoffdistallysothatthepapillarytrianglebe- tween21and22waslessprominent.Thecolourwas adjustedtothelivelycolourof11inthelaboratoryin thepresenceofthepatient(Figs.22&23).Theabut- ment(Fig.24)wasscrewedinatatorqueof20N/cm andthecrownwasinsertedforthreeweeksonapro- visional basis (Fig. 25). Final cementing has not yet been carried out as thetemporarycementingisverystableanditwasnot possibletoremovethecrownusingadequatemeans. Figure26showsthelipsandaportraitofthepatient. The functional and aesthetic restoration was there- fore successful. _Discussion Rapidtreatmentincasesofsecondimplantations is advantageous, as the alveolar is not changed any further or resorbed. Treatment with an antibiotic such as Clindamycin, that penetrates into the bone, should always be administered first to restrict the peri-implantinflammationandinflammationdueto thefracture.Aclosedapproachandadherencetothe standard required healing time is to be favoured in cases of an additional fracture of the alveolar bone or differences between the geometry of the implant andboneavailability,whichbothrequireaugmenta- tionprocedures.Situationswhereadiastemaispres- ent are particularly complicated from an aesthetic perspective.Thedivisionofthegapwhenusingcon- ventional prosthetics usually produces unsatisfac- tory results as the teeth with a replacement crown are wider than those without. In such cases, an im- plantistheonlyviablealternative.Theno.2thatwas rotatedinthecurrentcasewasfashionedmoreaes- thetically through application of a direct or indirect veneer and build-up of the papilla. However, the pa- tient's consent is prerequisite to this. Dispensationwithoratemporaldelaytoconven- tional permanent cementing does not constitute a contradiction to the production of a cemented crown. The timing of the final restoration can easily be delayed as the abutment is not susceptible to at- tack by caries and loosening of the crown is rapidly noticed. The crown is checked for loosening at the regularly spaced recall appointments._ Editorial note: A list of references is available from the publisher. Dr Michael Hopp Kranoldplatz 5,12209 Berlin,Germany ZTM Andreas Klar Certified DentalTechnician Dental Laboratory Rübeling & Klar Ruwersteig 43,12681 Berlin,Germany Prof Dr Reiner Biffar Ernst MoritzArndt University of Greifswald Centre of Dentistry and Oral Health Dept.of Prosthetic Dentistry and Dental Materials Rotgerberstr.8,17475 Greifswald,Germany _contact implants Fig. 22 Fig. 26 Fig. 23 Fig. 24 Fig. 25