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CD0412

I case report _ full-arch restoration Fig. 20_Revascularisation after one minute. Fig. 21_Crowns inserted. Fig. 22_Situation after inserting the crowns. Fig. 23_Restoration. _Abutment The running room for the provisional abutment was concave (Figs.1 & 2).9 After osseointegration, we modified the running room to a straight or slightly convex profile (Fig. 3), especially approxi- mally. The tissue extended from 0.5 to 1 mm in the directionofthecontactpoint.Thefinalconstruction followed the natural parameters of the interdental contactpointsinthenaturaldentition,asdefinedby Chu et al.10 Designing the interdental spaces as nar- row triangles with slight convexities, we managed to guide this tissue by another 0.5 to 1 mm to the idealcontactpoint,andgivetheentireconstruction a natural appearance. _Clinical case example A 50-year-old patient presented with a tooth mobility of Grade II to III (Figs. 5 & 6 ). He wished to havehisaestheticrestorationfixed.Incasessuchas this, an alternative chairside and laboratory work- flow can guide our treatment. Chairside workflow included an aesthetic analysis, impressions, a func- tionalanalysis,X-rays,CT,andevaluationofthehard and soft tissue. The treatment plan should be mini- mally invasive, of maximum effectiveness and aim forthebestaestheticresults.Thismeansimmediate implant placement and immediate loading. At the laboratory, a mock-up of the intended result was created. Afterwards, the mock-up was discussed with the patient and tried in chairside. At the next appointment, implant placement using a provi- sional and surgical, aesthetic-driven guide, fabri- cated by the laboratory in advance, and immediate restoration followed chairside. The implants were selectedinordertoallowimmediateloading(Fig.7). For immediate loading, an implant’s features and insertion protocol have to provide for high primary stability. Therefore, self-cutting threads and a drilling protocol for undersized implant site prepa- ration were necessary. Furthermore, the rough sur- face of the implant shoulder and the micro-thread design at the collar were important for long-term bone and soft-tissue stability. Platform-switched provisional abutments with concave running room andmadeofPEEK(polyetheretherketone)weread- ditionalfeaturesthatqualifiedtheimplantselected for immediate loading (Figs. 8 & 9). Another important aspect was the parameters applied in the immediate loading of the implants inserted in extraction sockets. Primary stability was achievedwithaninsertiontorqueof35Ncm.About threequartersoftheimplantsurfaceshouldbecov- ered by the host bone. The gap between the implant andthebuccalbonewasaugmentedtoamaximum of 1.5 mm (Tarnow 1997) (Fig. 7). Owing to these conditions, we were able to insert immediate im- plants and to perform immediate loading with a rigid fixed bridge (Fig. 10). After the osseointegra- tion (Figs. 11&12) individual abutments were CAD/CAMfabricatedfromzirconia(LAVA,3MESPE). Individually, the running room was modified to a slightly convex or straight profile (Figs.13–15), so that the tissue was shifted interdentally (Figs. 18–20) and another 0.5 to 1 mm was gained in papilla length. Tooth reconstruction was employed toproducethecrowns.Theconvexitiesofthecrown contour at the gingival margin were produced with respect to the harmony of the pink and white aes- thetics (Figs. 16 &17). Symmetry, the golden pro- portion and the individual demands of the patient were given particular consideration (Figs. 21–23). _Conclusion This treatment method, with the main aim of imitating or even improving the natural dentition, has been used for 12 full-arch cases over the last two years. Now, the paradigm of the short papilla between two implants is over. In order to obtain thenaturalgingivalarchitecturebetweenimplants, we adhere to the following: 36 I cosmeticdentistry 4_2012 Fig. 20 Fig. 21 Fig. 22