CD0412

I case report _ single tooth replacement _Information on patient and treatment At the age of 14, the 42-year-old female patient had experienced trauma to tooth #11, leading to luxation and tooth mobility. Endodontic treatment had been carried out in order to correct a discol- orationofthattoothaesthetically,whichhadbegun 15 years before the intervention. About ten years after the endodontic treatment, an apex resection had been necessary to treat a periapical infection. 30 I cosmeticdentistry 4_2012 Replacement of a single anterior tooth Surgical procedure and three-year results Author_Dr Peter Randelzhofer, Germany Initial presentation: Fig. 1_The patient had a high smile line, and tooth #11 was discoloured and had a poor prognosis. The gingiva was thick and the interdental papillae had a high-scalloped appearance. Fig. 2_Radiograph showing endodontic infection of tooth #11. Tooth extraction: Fig. 3_Careful extraction of tooth #11. Fig. 4_Good preservation of the marginal hard and soft tissue. Fig. 5_Intact coronal buccal bone plate: Note the thin interdental papillae. The remaining scar tissue of the former apex resection is clearly visible. Fig. 6_After a vestibular half-circle incision in the apical part of the keratinised gingiva, a flap was reflected downwards. Fig. 7_The apical bone defect is visible. Granuloma tissue and endodontic material were accurately removed with the help of a magnifying glass. Implant placement: Fig. 8_Accurate 3-D placement of a 4.3 mm diameter implant. Fig. 9_The implant was inserted with a palatinal orientation and a minimum distance of 2 mm to the buccal bone plate in order to prevent its resorption. The implant depth was 2 mm below the gingival sulcus and was dependent on the sulcus of tooth #21. To achieve a primary stability of a minimum of 35 Ncm, the final drill was not taken to its maximum depth. Fig. 10 Fig. 11 Fig. 12 Fig. 7 Fig. 8 Fig. 9 Fig. 4 Fig. 5 Fig. 6 Fig. 1 Fig. 2 Fig. 3