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implants - international magazine of oral implantology International Edition

I industry report fabricated and veneered the pressed ceramic caps for the crowns and veneers (Figs. 33–35). After a successful aesthetic try-in in the labora- tory (Figs. 36 & 45), the individual parts were com- bined.First,thetitaniumbasewassand-blastedand conditioned, then the secondary zirconium oxide abutmentwasconditioned.Bothpartswerebonded with special composite. Then the inner side of the veneer and the sintered zirconium oxide veneer ce- ramic of the hybrid abutment were etched with hy- drofluoric acid, conditioned and bonded with dual- curingcomposite(Fig.37).Then,thetransitionareas were smoothed and polished (Fig. 38). _Insertion The crowns were mounted by bonding and the implant-supported veneer crown was screw-re- tained (Figs. 39 & 40). This was followed by a care- ful check of the approximal contacts and function. ThefinalX-rayconfirmedsuccessfulosseointegra- tion of the implant and harmonious emergence of the implant-supported restoration from the bone (Fig. 41). Figures 42 to 45 show the aesthetically successful outcome and a very satisfied patient. _Discussion The example demonstrates successful immedi- ate implantation in the anterior maxilla of a female patient with a thin biotype and high smile line. In addition, the buccal bone lamella was missing, so that the bone and soft tissue had to be augmented as part of immediate implantation—without preparingaflap.Thisdemandingtaskcanonlysuc- ceed when the surgeon and if applicable the prosthodontist and the dental technician work to- gether as an optimal team and use suitable meth- ods and materials. In the case presented, surgery and prosthetics were performed by the same den- tist,whohadbeenworkingtogetherintensivelyfor many years with the dental technician in the same location.Atthebeginningoftreatment,thepatient presented to the laboratory for an aesthetic analy- sis to give the dental technician a detailed under- standing of the situation. In order to obtain adequate tissue volume in the implantation area, the surgeon employed proven boneandsoft-tissuesurgicalprocedures.Thesein- cluded using a bone mixture for augmentation and a tunnel technique for thickening the buccal soft tissue.10, 11 The literature shows that stable tissue volumeandaconstantmarginalsoft-tissueborder canbeachievedinthisway5,12 eveninthecaseofan impaired implantation site with missing bone lamella.8, 13 This procedure is not (yet) recom- mendedinthecurrentconsensusstatementsbythe professional associations owing to difficult pre- dictability of individual results.14 _Analogue and digital Alargepartofthetreatmentandtechnicalwork steps were performed with conventional surgical 30 I implants1_2014 Fig. 40_The palatally inserted crowns and the sealed screw access channel of the implant crown. Fig. 41_The X-ray check-up confirmed successful osseointegration and the natural emergence profile of the implant-supported restoration. Fig. 42_The crowns on teeth 12, 21 and 22 and the implant restoration in position 11 fitted harmoniously to the dental arch and the remaining teeth. Fig. 43_The close-up shows the healthy peri-implant soft tissue and the natural surface of the restorations. Fig. 44_The side profile also shows the natural contours of the restoration and the successful interplay between red and white. Fig. 45_The patient’s relaxed smile confirmed that the effort and attention to detail were appreciated. Fig. 43 Fig. 45Fig. 44 Fig. 40 Fig. 42Fig. 41