cosmetic dentistry_ beauty & science International Edition

technique _ periodontally compromised situation I Fig. 14_Re-entry with healing abutments. Fig. 15_Three weeks after re-entry. Fig. 16_Papilla morphology after healing abutments. Fig. 17_Definite abutments try-in. Fig. 18_Final prosthetics. Fig. 19_Pseudopapilla formation after three months of loading. The implants placed feature micro grooves at the implant neck in a height of 1 mm. This laser manu- factureddesignimitatesbiologyandpromisesanim- proved cell adhesion on this surface. These modern designs, combined with the advantages of platform switching, result in high tech products. Modern cre- stalbonemaintenancefunctionsbecauseofthepro- tectionofthecrestalbone.Whenimplantsareplaced subcrestallyorcrestally,asofttissueringbuildsonthe platform and protects the bone beneath. When im- plantsareplacedsupracrestally,implantneckoptions secure the crestal bone beneath, through soft tissue fibreattachmentoftheirnecks.23,24 In cases in wich primary closure is not possible or mobilization of neighbouring soft tissue through other flap designs is not wanted, temporary pros- theticsareessential.Thesofttissuemanipulationbe- gins from the very first moment and decides about theaestheticoutcome.25-27 The clinical situation after three weeks with heal- ing abutments needed to be altered buccaly at 11 and 21 and manipulated 0.5 mm apically. This was achieved via individualized abutments with convex base and breadth of 1 mm. In contrast, the gingiva marginsatthelateralincisorsneededtobecorrected coronally. Therefore, we used narrow abutments to givesofttissuemorespacetoheadcoronally.13-15 The combination of the biomaterials belongs to ourstandardaugmentationprotocolandiswelldoc- umented.Theresultsofguidedboneregenerationare predictableandcanbeplanned,eveninmajordefects. Inadditiontothecombinedbiomaterials,theirstruc- ture is very important. Rocky and edgy particles help internal stabilisation at the augmentation area. Often is an external stabilization with pins or screws unnecessary. The porosity of the particles is defined through their biology. This is the reason why we pre- fer no alloplastic biomaterials and take advantage of the pros of combined allografts and xenografts. Atthesametime,thesearetherequirementsofmod- ern biomatierials, accompanied of course by induc- tivity and conductivity. 28-30 Periodontal diseases are aregularlimitationfactorinoralimplantology.Thus, therearesituationsinwhichperiodontaldiseasepose no contraindication to implantology. Preconditions forsimilarproceduresareunderstandingandknowl- edge of biology, surgery and prosthetics. These pro- ceduresunderlienoalgorithmsbutproperdiagnosis, analysis and planning of every individual patient andthechoiceoftheappropriateimplantsystemand biomaterials.Modernimplantologyprovidesalltools forsuccessfulimplanttreatment.Complicationsare, however, severe and can hardly be solved without compromises._ Editorial note: A complete list of references is available fromthepublisher. I 41cosmeticdentistry 1_2014 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Dr Nikolaos Papagiannoulis Steigmann Institute Bahnhofstraße 64 69151 Neckargemünd,Germany m.steigmann@t-online.de www.implantologie-heidelberg.de cosmeticdentistry _contact CDE0114_38-41_Papagiannoulis 11.06.14 14:09 Seite 4