CD0412

I case report _ full-arch restoration Fig. 1_The platform-switching design of the implants facilitated preservation of bone at the collar and the gaining of supra-crestal fibres. Fig. 2_Concave profile of the provisional abutment. Fig. 3_Convex profile of the final individual abutment. _Introduction The target of modern dentistry is the achieve- ment of a natural aesthetic outcome, function and stability using a minimally invasive, maximally ef- fective technique and in a reasonable period. This case study demonstrates that new philosophies concerning implant design, provisional and final abutmentdesign,aswellasparadigmshiftsintreat- ment approaches, can lead to superior aesthetic results. In full-arch implant-supported restoration, immediate placement with immediate loading has been well documented. The literature shows a high success rate of 97% with this kind of treatment in the mandible11-17 and of 96% in the maxilla.18-20 Osseointegration of implants has been achieved routinely and with a high degree of success. Con- temporary implant dentistry focuses on aesthetic success aside from functional results. One of the compromisesinaestheticsinasituationofadjacent implants is the short papilla between two im- plants, where a maximum length of 3.5 mm can be achieved.1 Thiscanbeexplainedbylossoftheinter- implant bone. The advantages of a platform-switched implant design regarding bone and tissue stability are well documentedintheliterature.2–6 Theresultingstabil- ity of the bone is explained through the increased distance of the micro-gap from the bone (a mini- mum of 0.45 mm is adequate). Another way to pre- serveboneinthelongtermisbyselectinganimplant design with a micro-thread design at the collar. Thepositiveinfluenceofthemicro-threaddesignat the collar of the implant has been biomechanically explainedbySteigengaetal.7 Boneisstrongerwhen loadedincompression,and30%weakerwhensub- jected to tensile forces. During function, the shear forces are transformed into small compression and traction forces. Another observed benefit of plat- formswitchingisthenon-surgicalincreaseintissue volume in the healing phase. _Papillary area Additionally, Gargiulio8 has demonstrated that the higher the peri-implant soft tissue, the lower the risk of bone loss in the process of increasing the biological width.8 Through decreased bone loss and a resulting reduction in bone instability, as well as increased thickness of the tissue, more supra- crestal fibres can be gained (Figs.1 & 2). Owing to this philosophy in designing the provisional, the final abutment and the crown, we were able to manipulatethesofttissue(Fig.3)andgainaninter- implant papilla length comparable to the length of the papilla between two natural teeth (5 mm, Fig .4). Modifiedclinicalapproach forimprovedaesthetics infull-archrestoration Authors_Dr Henriette Lerner, Germany, Prof. Z. Jacobson & Dr Hugh Flax, USA 34 I cosmeticdentistry 4_2012 Fig. 2 Fig. 3Fig. 1