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CAD/CAM international magazine of digital dentistry

32 I I industry report _ single-tooth implants three years, conditions remained stable with a pleasing aesthetic appearance (Figs. 15 & 16). _Discussion Implants for single-tooth replacement are an important and established treatment concept. For this case, an implant was placed soon after extraction of the traumatised tooth because this appeared to be the most appropriate protocol, also with regard to the good condition of the re- maining teeth. A number of investigations have found ridge atrophy during the first year of tooth loss. As a rule, atrophy commences after the third week and the Crista alveolaris decreases by 30 to 50 % within a year. To protect the bone against increasing degen- eration through physiological load, the implant should ideally be placed directly after tooth ex- traction (immediate implant placement) or after four to six weeks at the latest (delayed immediate implant placement), once soft tissue healing is complete. If the gingiva and bone are not in- volved, the implant can be placed immediately. In cases in which the tooth has been lost for endodontic reasons (owing to periodontal dis- ease or following trauma with bone and gingiva loss), augmentative procedures are usually also required. To ensure secure healing of the mem- branes and soft tissue grafts used for augmen- tation, the surgical area should be covered completely to allow primary healing. Ideally, the soft tissue is given four to six weeks to regenerate before placing the implant. Primary wound heal- ing can be ensured by placing a free gingival graft over the extraction wound. To provide long-term success of the implant, the endosseous part of the implant must be cov- ered completely by bone. Here, the vestibular re- gionsoftheimplantsplayamajorrole.Afterbone reconstruction, it is also important to cover the entire region with soft tissue. The combination of bone reconstruction and grafting with autoge- nous bone, which can be collected using a bone trap for example, has proven a highly practicable method for augmentation. By covering with an absorbable collagen membrane, the soft tissue is isolatedfromtheregenerativeregion.Inthiscase, as the vestibular soft tissue was of insufficient volume despite the free gingival graft, a palatal connective tissue graft was placed in addition to the augmented region. The thickness of the soft tissue affects the degree of recession. As a thick gingiva is better nourished, a connective tissue graft is often used in aesthetic regions. In the case of single-tooth restorations, the localisation of the implant is the most important factor for achieving aesthetically pleasing recon- struction. Templates should be used for position- ing. If this is not possible, the manual methods in use for years can be employed. The length of the papillae, measured with a periodontal probe, bone thickness and the vestibular lamellae are very important for long-term stable treatment. In our case, we used the Iglhaut locator because the implant was not placed directly into the alveolar socket but into a more palatal-oriented position. We know from the literature that soft tissue is a mirror of the bone. Using a palatal connective tissue graft, a thin gingival biotype can be con- verted into a thick biotype. In our case, we em- ployedanenvelopetechniquefortransplantation of the sufficiently dimensioned palatal-source mucosa graft. If the soft tissue is thick enough, it is possible to shape gingiva and papillae with temporary crowns. In addition, if there is suffi- cient distance to the bone, the papillae can even be extended. Pressure is exerted on the papillae to profile them in the direction of the crown. Sufficient connective tissue thickness prevents the showing through of titanium, but a darker discolouration is definitely avoided by using zir- conium dioxide abutments. _Summary Additional bone and soft tissue constructions are usually necessary to provide a long-term appealing reconstruction with single implants in theaestheticzone,andlocalisationoftheimplant must be planned accurately. The implant should be placed as soon as possible after tooth loss. Zirconium dioxide is a proven material for abut- ments._ Editorial note: This article was first published in IDENTITY 2/11. A complete list of references is available from the author. CAD/CAM 3_2012 Dr Ata Anil Ardent Dental Clinic Teşvikiye Cad.49/10 34365 Nişantaşı Istanbul Turkey ataanil@ar-dent.com www.ar-dent.com CAD/CAM_contact