implants - international magazine of oral implantology

I case report Fig. 1_Initial situation. Fig. 2_Preoperative panoramic radiograph. Fig. 3_Tooth 11 post-op. Fig. 4_Tooth 22 post-op. Fig. 5_Implant insertion tooth 11. Fig. 6_Implant inserted in tooth 11. GTR and recession coverage in immediate implantation Authors_Dr N. Papagiannoulis, Dr E. Sandberg & Dr M. Steigmann, Germany 14 I implants3_2013 Fig. 5 Fig. 6 Fig. 2 Fig. 3 Fig. 4 Fig. 1 _Introduction Among the difficulties and challenges in immedi- ate implantation, local inflammations of the hard or soft tissue are major criteria on how we implant. The behaviour after implantation, especially of the soft tissue,isonlypredictablewhenthediagnosisandthe treatment concept are correct. Gum recessions are potential contra-indications for immediate implant placement. Nevertheless, we have to take into consideration that soft tissue and recession coverage techniques function differently when applied to implants. A cal- culated risk is acceptable if the procedure prevents soft and hard tissue from absorbing, which can lead to compromised aesthetics and an unsatisfied pa- tient. _Clinical and radiological findings The patient visited the practice complaining about compromisedaestheticsoftheanteriormaxilla.Thefirst examinationshowedachallengingsituationofteeth11 and22.Inthepastyears,thealmost30-year-oldpatient hadexperiencedthewholerangeofdentistry,including endodontology,periodontology,andsurgicalcrownex- tension. Teeth 11 and 22 were insufficiently restored, with tooth 11 showing a soft tissue recession Miller class 2 andtooth22showinganapicalinflammation.Bleeding onprobingwaspositivein11(grade4),sowerepercus- sion and mobility in 22. The crown in tooth 11 was overextended, probably to cover recession. Crown 22 wasalsooverextended,leadingtosecondarycaries.The periodontal screening index on 11 was grade 3 with