cosmetic dentistry_ beauty & science International Edition

I technique _ periodontally compromised situation 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 around the root was like a crater, infiltrated with soft 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- ing on the art of the restoration, teeth often have to be extracted, in spite of successful periodontal treatment. So the question to be asked is whether and when a periodontal treatment makes sense as a definite treatment or if it should be a tool that enhances 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 severely from loss of interproximal bone, followed bymesiorotationsandante-inclination(Figs.1&2). Radiological findings confirmed that all four upper incisors needed to be extracted. Maximal aesthetics in the periodontally compromised anterior maxilla Immediate implantation Authors_Drs Nikolaos Papagiannoulis, Eduard Sandberg & Marius Steigmann, Germany 38 I cosmeticdentistry 1_2014 Fig. 1 Fig. 3Fig. 2 CDE0114_38-41_Papagiannoulis 11.06.14 14:09 Seite 1