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implants - international magazine of oral implantology International Edition

I industry report Fig. 1_The female patient wanted new restorations with bright, natural-looking crowns in regions 12 to 22. Fig. 2_Tooth 11 could not be saved and was to be replaced with an implant. Fig. 3_The photographs and situation models were analysed in terms of aesthetics, and all details diligently recorded on the relevant form. _Introduction Implant-supported single-tooth crowns in the aesthetic zone are a special challenge, particularly when immediate implantation is planned—if there is insufficient bone volume and a thin biotype. A whole chain of critical factors need to be consid- ered here, including implant positioning,1, 2 hard- andsoft-tissuemanagement3–5 andthenaturalde- sign of the crown.6 These days, a number of digital methods are available to simplify the process and make it safer.7 Depending on the initial situation, that is maximum aesthetic demands, however, many dentists prefer analogue methods, as in the following example. _Initial findings and planning A young female patient with full-ceramic crownsonteeth12to22presentedatourclinicde- siring bright and natural new restorations (Fig. 1). Hermedicalhistorywasunremarkableandhergin- givaltypewasclassifiedasthin.Tooth11,whichhad undergone root canal therapy, could not be saved andwouldhavetobereplacedwithanimplantow- ing to a weakening of tooth substance, resulting fromexcessivecavitationaspartofpost-endodon- tic restoration (Fig. 2). In addition, the existing crown kept coming off owing to the poorly reten- tive design of the abutment. Inordertoobtainthemostaccurateassessment of the initial situation, the dental technician pho- tographed the patient in his laboratory. Using the photograph and initial models, he defined the shape and colour of the planned restorations and carefully analysed their position in the arch for the temporary restoration (Fig. 3). Based on the data obtained, a temporary bridge was fabricated for teeth 12 to 21 once tooth 11 had been extracted. _Immediate implantation and temporary restoration In order to extract tooth 11 with as little trauma aspossible,thesurgeonfirstseveredtheperiodon- tal fibre system with a periotome (Fig. 4) and ex- panded the coronal alveolar gap with piezo-surgi- cal instruments. First, the crown was luxated and extracted with extraction pliers, then the root, Immediate implantation and full-ceramic restoration in the maxillary anterior region Authors_Dr Arndt Happe & Andreas Nolte, Germany 24 I implants1_2014 Fig. 1 Fig. 3Fig. 2