implants - international magazine of oral implantology

I industry report Fig. 1_Initial situation: smile line level, line of the gingiva and upper lip. Fig. 2_Scarring of the gum as a result of a previous apicoectomy. Fig. 3_Crowding of teeth 11 and 12, convoluted dentition. _Information on patient and treatment The female patient was 40 years old at the begin- ningofthetreatment.Thehighsmilelineandthethin gingival phenotype significantly complicated the case. Tooth 11 and tooth 12 had grayish crowns and lividgums.Therootsofbothofthetwoteethhadbeen treated,beforeametalpinhadbeeninsertedintooth 11alioloco.Anapicoectomyhadalsobeenconducted on tooth 12, which had left scarring with partial re- tractionofthegingiva.Theapicoectomywasnotfully healed when the medical history was taken, and the root canal filling at tooth 12 appeared too short api- cally. Tooth11hadtobeatraumaticallyremoved,andwe decided in favor of an immediate implant placement followed by a temporary restoration using a tempo- rary shell crown. An impression was taken during the procedurewiththe“earlyabutmenttechnique”toal- lowtheimplantpositiontobetransferredtothemas- ter cast for early manufacture of the final abutment. After regenerative measures for rebuilding hard andsofttissuebythepouchtechniqueanddeliveryof the long-term temporary denture, the patient was discharged.Thefinalabutmentswereplacedonlytwo days later and were not unscrewed, again. This was the only way of establishing a thick periimplant soft- tissue collar and minimizing the soft-tissue retrac- tion. The final full-ceramic crown was placed twelve months later. _Initial situation The patient had a smile line level with and above the cervix. The line of the gingiva and upper lip ap- pearedirregular(Fig.1).Incipientpapillalosscouldbe seen in regions 11 to 13. The gum showed scarring as a result of a previous apicoectomy. The crowns ap- peared gray. The gingiva had a livid discoloration, wherethedarkrootstumpsshowedthroughbecause of the thin phenotype (Fig. 2). The crowding of teeth 11and12andtheconvoluteddentitionmadethesit- uation implantologically and esthetically difficult (Fig. 3). _Atraumatic removal of the residual root Ametalpinplacedaliolocowasvisibleattooth11. The apicoectomy had not yet healed. The root canal fillingattooth12appearedtooshortattheapex(Fig. 4). To remove tooth 11, a computer-controlled injec- tor (The Wand, Milestone) was used for a palatal in- jection. This protects the scarred tissue almost com- pletely and does not affect the blood supply (Fig. 5). Atraumatic removal of the residual root 11 followed. The inflamed tissue was completely scraped out (Fig. 6). The early abutment technique Author_Dr S. Marcus Beschnidt, Germany 34 I implants3_2012 Fig. 2 Fig. 3Fig. 1