CD0412

I case report _ central incisor restoration 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 Implants) 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 XiVE Splusimplant(DENTSPLYImplants;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 implant and an EsthetiCap plastic abutment (both DENTSPLYImplants)wasfittedontheimplant(Fig.9). The design of this anatomically shaped abutment supports the soft tissue and interdental papillae adequately. Furthermore, it enables the creation of a suitable emergence profile from the moment of implant placement. The highly polished surfaces prohibit accumulation of dental plaque and facili- tate oral hygiene. At this stage, soft-tissue support is crucial for achieving an aesthetic result for the provisional restoration and maintaining it to the final stage. The previously fabricated provisional crown was fittedontheabutmentwithautopolymerisedacrylic resin, maintaining the access hole on the palatal aspect for the fixation screw (Fig. 10). Furthermore, the outer contour of the provisional crown was checked repeatedly to ensure support of the gingi- val margin without excessive pressure, which could lead to tissue shrinkage. The provisional crown was designed1mmshorterthantooth#21toavoidpos- sible occlusal 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 Implants) was selected. This abutment offers adequate soft-tissue support and a suitable 26 I cosmeticdentistry 4_2012 Fig. 14 Fig. 15 Fig. 11 Fig. 12 Fig. 13 Fig. 10