CD0412

case report _ single tooth replacement I Owing to pulsating pain and the previous endodontic treatment, the tooth was considered hopeless with regard to an optimal long-term out- come and was to be extracted. The X-ray examina- tionconfirmedachronicinfectionaroundtheapex. The soft tissue was intact with a satisfactory at- tachmentleveltotheneighbouringteeth.Thequal- ityoftheratherthickgingivawasgood.Theincision I 31cosmeticdentistry 4_2012 Bone augmentation: Fig. 10_Augmentation of the remaining spaces between the 4 mm bottle-neck healing abutment and the buccal bone plate with Bio-Oss particles (Geistlich). Fig. 11_Additional augmentation of the apical bone plate with grafting material. Use of a membrane was not necessary because of the anatomical shape of the defect. Fig. 12_Primary wound closure with 5.0 resorbable vicryl sutures. The apical flap was closed conventionally. Fig. 13_The bottle-neck design of the transmucosal abutment enabled a tensionless wound closure. Healing: Fig. 14_Four weeks post-op: Good soft-tissue healing and gingival adaptation around the bottle-neck abutment. Fig. 15_Stable papillae, nicely preserved soft-tissue volume. The temporary crown was used to establish a natural sulcus around an implant crown. Fig. 16_The removable provisional, used by the patient for the four-month healing period, showed adequate gingival height for a functionally and aesthetically acceptable result. Fig. 17_Nicely healed and healthy soft tissue around a well-integrated implant, replacing tooth #11. The absence of scar tissue thanks to the flap design is obvious. Soft-tissue management: Fig. 18_Placement of a temporary crown with soft-tissue management for a natural looking emergence profile. The submerged part of the occlusal screw-retained crown (concave tulip-shaped design) supported the subgingival soft tissue. Fig. 19_The screw channel (perforating the labial part of the crown) was covered with a composite inlay. Farther apically, the scar tissue from the earlier apex resection was easily removed. Fig. 20_Natural-looking emergence profile. The mesial part needed to be built up a little more. Fig. 19 Fig. 20 Fig. 21 Fig. 16 Fig. 17 Fig. 18 Fig. 13 Fig. 14 Fig. 15 Fig. 28 Fig. 29 Fig. 30 Fig. 25 Fig. 26 Fig. 27 Fig. 22 Fig. 23 Fig. 24