implants - international magazine of oral implantology

I case report 18 I implants3_2013 The correct abutment and crown insertion (Figs. 24 &25)werecontrolledwithX-rays(Fig.26).Notonly didthesurgicalpartleadtosuchhighlyaestheticresults, but also the technical part played a crucial role in the aesthetic outcome (Figs. 27–31). The soft tissue situa- tion showed a slight improvement of the papilla on tooth11fourweeksafterloading. _Discussion Thedecisiontoextracttheteethandplaceimplants immediatelyisalwaysarisk.Thisriskisloweredifweun- derstandwhythetoothhadtoberemoved,howbiology works and what we can or must not do. In this case, a flapraiseorpapillaraisewouldhavebeenfatalwithre- gardtoaesthetics,resultinginunpredictableandmajor defects. The implant position slightly beneath the cre- stal bone level is correct, calculating the inevitable loss of crestal height through the former local inflamma- tion.Thegraftingofthebuccalplategapisalsoappro- priate and leads to a higher predictability when per- formedwithacombinationoffastandslow,orslowand non-resorbablebiomaterials. Platformswitchingisausefultechniquetooffersoft tissueorhardtissuespacetogrowandastablescaffold for support. When the system offers real platform switching,asseenhere,hardtissuegrowingonthere- verselybevelledimplantneckpreventscrestalbonere- sorption. Especially soft tissue growing and covering the implant neck will form a tissue ring around it, pro- tecting the crestal bone from resorption as well. Pros- thetics are as important as the surgical part. They en- compassthefinalrestorationwiththeemergencepro- file, the proximal contact and margin design, but the temporary restoration also is crucial for soft tissue maintenance,managementandlong-termstability.As can be seen from the recall photos four weeks after loading,thesofttissuefillstheproximalgapsifthecon- ditionsforitarefulfilled.Theinitialrecessionisgoneand we created enough soft tissue for good aesthetic re- sults. The tight interdisciplinary collaboration between surgeon,technicianandrestorativedentistfinallyguar- anteedasatisfactoryresultandahappypatient.20-25 _ Fig. 28_Occlusion. Fig. 29_Left. Fig. 30_Right. Fig. 31_Smile. Fig. 31Fig. 30 Fig. 29Fig. 28 Dr N.Papagiannoulis Proaesthetic Dental Praxis für kosm.ZHK und Implantologie Brückenkopfstr.1/2 69120 Heidelberg,Germany Tel.:06221 9986482 Fax:06221 9986484 www.fsde.com.gr Dr E.Sandberg Zahnarztpraxis Dr Sandberg & Kollegen Liebigstraße 11 60323 Frankfur/Main,Germany Tel.:069 97097171 Fax:069 97097272 www.dr-sandberg.de Steigmann Institute Bahnhofstraße 64 69151 Neckargemünd,Germany _contact implants