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ePaper created 2014-08-26, 21:44:32 | version 1.30.01
I case report _ implant-supported single-tooth restoration 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 im- mediate implantation is planned—if there is insufficient bone vol- umeandathinbiotype. Awholechainofcritical factors need to be con- sidered here, including implant positioning1, 2 , hard- and soft-tissue management3–5 and the natural design 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 analoguemethods,asinthefollowingexample. _Initial findings and planning A young female patient with full-ceramic crowns onteeth12to22presentedatourclinicdesiringbright and natural new restorations (Fig. 1). Her medical history was unremarkable and her gingival type was classified as thin. Tooth 11, which had undergone root canaltherapy,couldnotbesavedandwouldhavetobe replaced with an implant owing to a weakening of toothsubstance,resultingfromexcessivecavitationas partofpost-endodonticrestoration(Fig.2).Inaddition, theexistingcrownkeptcomingoffowingtothepoorly retentivedesignoftheabutment. In order to obtain the most accurate assessment 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 temporarybridgewasfabricatedforteeth12to21once tooth11hadbeenextracted. _Immediate implantation and temporary restoration In order to extract tooth 11 with as little trauma as possible, the surgeon first severed the periodontal fibresystemwithaperiotome(Fig.4)andexpandedthe coronalalveolargapwithpiezo-surgicalinstruments. First, the crown was luxated and extracted with ex- tractionpliers,thentheroot,againwithpiezo-surgery, a sharp lever and diamond pliers. This revealed that the thin buccal bone lamella was connected to the root (Fig. 5). The osseous margin of the alveolus was examined carefully with a periodontal probe (bone sounding). Despite a lack of bone wall, an immediate implan- tation as planned was to be performed according to the protocol of the University Medical Center of the Johannes Gutenberg University of Mainz, Germany.8 With the aid of the guide prepared in the laboratory; the positions were marked prior to preparing the im- plantbed(Fig.6).Pilotdrillingandfurtherdrillingsteps were performed by the surgeon without a guide and withdrillextensionforoptimalcooling.Insertionofthe implant(CONELOG,CAMLOG;3.8mmdiameter,13mm length)wasalsoperformedwithoutaguide(Fig.7). Correct3-Dorientationoftheimplantwaschecked with the final drill and using the drill guide. The buccal implant shoulder should be 3 mm apical of the mar- ginalsofttissueanddistinctlypalataltothedentalarch (Figs.8&9).Thisensuresthatthesubsequentimplant- supported crown can be screwed in palatally. The gap between the implant and buccal soft tissue was filled with bone material. This was a mixture of autologous bone gained during preparation. Granular autologous bone harvested from the retromolar area and bovine Immediate implantation and full-ceramic restorationin the maxillary anterior region Authors_Dr Arndt Happe & Andreas Nolte, Germany 26 I CAD/CAM 3_2014 Fig. 1 Fig. 3Fig. 2 CAD0314_26-32_Happe 22.08.14 14:24 Seite 1