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CAD/CAM international magazine of digital dentistry

16 I I case report _ implant prosthetic restoration _Introduction Being able to replace missing teeth by means of implants has opened up new opportunities in patient care and revolutionised the field of pros- thetic rehabilitation. Progress in implant design and in surgical technique has increased the pre- dictability of the treatment results and the sur- vival rates of implants and implant-supported prostheses. In the maxilla, however, owing to the anatomicalconditions,implanttherapycurrently has its limits. Due to its cancellous bone structure, the maxilla does not offer optimal conditions for the primary and long-term stability of implants. The maxillary sinus is a further factor that makes theplanningandinsertionofimplantsinthepos- terior region of the maxilla difficult and requires extensive pre-implantation measures to prepare the implant site. From an aesthetic perspective, implant treat- ment in the maxillary anterior region is a chal- lenge for dentists. The smallest error in the posi- tioning of the implant or improper handling of the peri-implant hard and soft tissue can lead to an irreversible cosmetic failure. Single-tooth im- plants in particular require all of the dentist’s skills. In patients with a thin biotype, the visibility of the abutment through the thin gingiva pres- ents a common problem. Post-operative recession, resulting in parts of the implant becoming visible, is also com- mon. Such recession generally occurs when a too large implant diameter has been selected or the implant has been positioned too close to the vestibular surface. CAD/CAM 4_2012 Fig. 1_Along with the natural, healthy dentition, the initial dental orthopantomogram shows the orthodontic brackets and archwires in the maxilla and mandible. Fig. 2_In the transverse DVT view, a XiVE implant was virtually inserted in the optimal implant position. The buccal lamella fell short of the necessary layer thickness of 1 to 1.5 mm. Fig. 3_The route of the nasopalatine nerve can be estimated on the axial view of the 3-D image. Early childhood anterior tooth trauma Implant-prosthetic restoration with a XiVE implant following piezoelectric bone splitting and bone grafting Author_ Dr Fred Bergmann, Germany Fig. 1 Fig. 2 Fig. 3