implants0112

I case study Fig. 10_Implant-supported, screw-retained provisional restoration. Fig. 11_Clinical situation one week post-implant placement. Fig. 12_Corresponding X-ray. Fig. 13_Occlusal view of the soft- tissue contour at the end of osseointegration. Fig. 14_Facial view of the soft-tissue contour at the end of osseointegration. Fig. 15_Impression coping customised in the cervical area to match the emergence profile of the provisional crown. at all stages of the treatment. Before the start of the surgical treatment, initial impressions were taken with alginate. Study models were fabricated based on these and then mounted on a semi-ad- justablearticulator.Adetailedwax-upwasmadefor tooth #11 and a provisional crown was fabricated fromheat-polymerisedacrylicresin.Theprovisional crown was trimmed at the interior surfaces for use with a provisional implant abutment. The periodontal fibres surrounding tooth #11 in the alveolar socket were loosened with a periotome (DENTSPLY Friadent) and the tooth was extracted atraumatically (Figs. 4 & 5). The horizontal fracture of the root below the cervical area of the extracted toothverifiedtheinitialdiagnosis(Fig.6).Thesocket walls were considered intact and inspection re- vealed no signs of fenestration. Any residual fibres werescrapedoff.Theimplantsitewasthenprepared according to the manufacturer’s guidelines and a XiVESplusimplant(DENTSPLYFriadent;4.5x11mm) was inserted with sufficient initial stability, which was mainly achieved on the palatal side of the im- plantsite.Theimplantcollarwasplaced3mmbelow the cemento-enamel junction of the adjacent teeth (Figs. 7 & 8). The titanium TempBase abutment, which acted as the placement head, was removed from the im- plant and an EsthetiCap plastic abutment (both DENTSPLY Friadent) was fitted on the implant (Fig. 9).Thedesignofthisanatomicallyshapedabutment supportsthesofttissueandinterdentalpapillaead- equately. Furthermore, it enables the creation of a suitableemergenceprofilefromthemomentofim- plant placement. The highly polished surfaces pro- hibit accumulation of dental plaque and facilitate oral hygiene. At this stage, soft-tissue support is crucial for achieving an aesthetic result for the pro- visional restoration and maintaining it to the final stage. The previously fabricated provisional crown was fittedontheabutmentwithautopolymerisedacrylic resin,maintainingtheaccessholeonthepalatalas- pectforthefixationscrew(Fig.10).Furthermore,the outercontouroftheprovisionalcrownwaschecked repeatedlytoensuresupportofthegingivalmargin without excessive pressure, which could lead to tis- sue shrinkage. The provisional crown was designed 1 mm shorter than tooth #21 to avoid possible oc- clusal loading at maximum intercuspation or side movement (Fig. 11). The implant position in the socket and the abutment fit were checked radi- ographically (Fig. 12). The osseointegration period of four months was uneventful and the soft tissue around the implant didnotexhibitanysignsofinflammation.Theinter- dental papillae were maintained in shape, height and volume (Figs. 13 & 14). In order to support the softtissuearoundtheimplantforimpressiontaking, a prefabricated impression coping was customised using photopolymerised low-viscosity composite material (Figs. 15 & 16). For this implant, an all-ce- ramic prefabricated zirconium CERCON abutment (DENTSPLY Friadent) was selected. This abutment offers adequate soft-tissue support and a suitable 30 I implants1_2012 Fig. 14 Fig. 15 Fig. 11 Fig. 12 Fig. 13 Fig. 10