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implants - the journal of oral implantology UK Edition

I 27 clinical _ CBCT I implants1_2012 placement in the anterior mandible. _Patient history A 44-year-old female who has been under- going long term periodontal treatment pre- sented with mobile and painful lower incisors. She exhibited very good oral hygiene but with a periapical area and mobility associated with the UR4 and grade 2 mobility of her lower incisors. The patient described difficulty and embarrassment when eating due to the move- ment of her lower teeth and wanted a fixed solution. _Clinical examination The patient had a lightly restored denti- tion with a thin gingival biotype. As previously mentioned, her oral hygiene was good and she was a non-smoker (gave up 11 years previous- ly). She exhibited bi-lateral canine guidance with no evidence of any parafunction. Her BPE scores were 312/231. _Treatment options: Due to the patients’ history of periodontal disease and associated mobility, she was aware that some form of replacement was necessary. The patient did not want a removable restora- tion and preferred a fixed solution. In this area of the mouth either fixed bridgework or an im- plant retained prosthesis were possible. After discussing the options, and highlighting the increased risk of peri-implantitis of implants in patients with previous periodontal disease, (Esposito 2006) the patient opted for a fixed implant retained solution. The treatment was to be planned in such a way that if she lost her posterior molars in the future, a full arch fixed prosthesis could be made after subsequent im- plant placement. _Treatment plan: 1. Continuation of periodontal treatment and oral hygiene advice 2. CBCT Sirona Galileos scan to assess bone height, bone profile and associated anatomy. 3. Extraction of all four lower incisors and the UR4 4. Placement of two Straumann SLA active im- plants 5. Restoration with a Screw retained 4 unit PFM bridge _CBCT It was decided to take a full volume CBCT to further assess the upper teeth and the UR4 for future implant replacement. The CBCT showed excessive bone loss around the anterior inci- sors with a small area of periapical radiolu- cency around the LL1. A cross-sectional view showed thick well developed cortical plates Fig 4_A CBCT with a CEREC Blu - cam overlap showing the ideal result . Fig. 4