Cosmetic dentistry beauty & science

case report _ delayed immediate implantation I I 31cosmeticdentistry 3_2013 1.Preparationforatightclosure After gentle and non-traumatic extraction of thenon-conservabletooth,themarginalgingivais minimally detached to the alveolar process so that the free membrane side of the collagen membrane and cone unit can be inserted. 2.Customisingcollagenmembraneandconeunit Moistening is to be avoided because this would make it more difficult to achieve a good fit to the alveolus. Rather, the collagen cone is fitted to the alveolus with the scalpel, and the membrane is configured with small scissors to facilitate in- sertion under the marginal edges, while at the same time achieving an ideal defect-congruent coverage. To achieve this, the dimensions of the mem- braneshouldbeapproximately1–2mmwiderthan the diameter of the alveolus. 3.Insertionofcollagenmembraneandconeunit Using dry, anatomical, wide tweezers, the col- lagen membrane and cone units are inserted into the alveolus and then pushed in deep with a moist swab. The membrane part should be seated exactly at the level of the marginal gingiva. Now the free and slightly oversized part of the membrane is pushed carefully under the edges of the marginal gingiva. 4.Protectivemeasures Aback-and-forthsuturewithanon-absorbable suture material will secure the position of the collagen membrane and cone unit in the alveolus and also adapt the free gingiva edges on the membrane. _Case presentations The following three patient cases serve to il- lustrate and ultimately evaluate the procedure of a delayed immediate implantation using an ab- sorbable collagen membrane and cone unit. Case 1: Four non-conservable teeth in the anterior maxilla Due to a trauma of the anterior teeth during adolescence, the patient received endodontic treatment and crowns on the four front teeth, which—after recurring problems—resulted in api- coectomies. The second set of crowns at ten years after the first prosthetic treatment was followed immediately by a second resection due to persist- ent discomfort. The patient is in her late thirties, and now the four front teeth 12, 11, 21, 22 are no longer conservable. They showed mobility grades of I–II, high circular probing depths and bleeding on probing. Afteraremovableinterimprosthesis12–22was produced, the four teeth in the anterior maxilla Figure 2l shows the inserted abutments, and Figure 2m shows the integrated product in the patient’s mouth. Figure 2n shows the corresponding sagittal view. Fig. 2k Fig. 2l Fig. 2m Fig. 2n