implants - international magazine of oral implantology International Edition

I research Fig. 1_Initial clinical situation. Fig. 2_Initial clinical situation, coronally. Fig. 3_Situation models for provisional planning. _Introduction Inadditiontohabits,systemicdiseasesandbrux- ism, periodontal diseases are challenging problems in oral implantology. Here, surgeons have to deal with tooth loss, prolonged epithelia, bone resorp- tionandlossofperiodontalligament.Inthefollow- ing case, we could clearly see at the preclinical analysis that major bone resorption had occurred horizontally as well as vertically. The bony defects referred to more than one wall, the bone resorption aroundtherootwaslikeacrater,infiltratedwithsoft tissue. Primary stability was difficult to achieve for the implant. The periodontal treatment was the primary fo- cus, accompanied by fillings and extraction therapy to cure acute inflammations and achieve oral health. Nevertheless, periodontal treatments result inregulartofunctionallyandaestheticallycompro- mised situations and unsatisfied patients. Further, periodontal treatment does not secure the ade- quate prosthetic treatment of the patient. Depend- ingontheartoftherestoration,teethoftenhaveto be extracted, in spite of successful periodontal treatment. So the question to be asked is whether andwhenaperiodontaltreatmentmakessenseasa definite treatment or if it should be a tool that en- hances later surgical and restorative procedures. _Clinical and radiological findings The clinical examination showed a severe peri- odontaldefect,screeningindexofGradeIV,pockets of up to 6 mm, tooth mobility grade II–III and a bleeding index of 3–4. The functionality was very limited and the aesthetic situation unsatisfactory. Theexistingprostheticsonthecentralincisorswere toolongtocovertherecessions,resultinginfurther attachment loss. The aesthetics also were compro- mised, following periodontal fibre loss and bone support. Especially the lateral incisors suffered se- verely from loss of interproximal bone, followed by mesiorotations and ante-inclination (Figs. 1 and 2). Radiological findings confirmed that all four upper incisors needed to be extracted. Maximal aesthetics in the periodontally compromised anterior maxilla Immediate implantation Authors_Dr Nikolaos Papagiannoulis, Dr Eduard Sandberg & Dr Marius Steigmann, Germany 06 I implants1_2014 Fig. 1 Fig. 3Fig. 2