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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
_This case required a precise evaluation of the different alternative approaches and clinical deci- sionmakingbeforedecidingonthefinaltreatment. Asurgicalapproachwouldhaveinvolvedextraction of teeth 11, 12 and 21, and enucleation of the sig- nificantcystseeninthepre-surgicalCBCTscan,fol- lowed by bone grafting to fill the cavity. This would haverequiredplacementofanadditionaloneortwo implants and restoration with either three single implant-retained crowns or an implant-supported three-unit bridge. It was determined that the sur- gical approach was too traumatic and would cause extensive loss of vital tissues, making it difficult to establish a good aesthetic result later on. It also would have required the patient to lose three of his four front teeth, which would have been psycho- logicallytraumatic.Endodontictherapywaschosen insteadinordertodecompressthecystandthereby save the teeth, retain the ridge form and preserve the interdental papillary tissue and architecture. The initial view of the linked crowns at the 11 and 21 sites showed an unaesthetic appearance with poor soft tissue health and colour (Fig. 1). 14 I I case report _ CBCT in dental implantology cone beam4_2014 Fig. 1_Initial clinical situation. Figs. 2a & b_Initial situation. Pre-treatment radiograph (a). Pre-surgical CBCT (b). Fig. 3_Extraction socket of tooth 21. Fig. 4_Socket graft region 21. Fig. 5_Temporary restorations. Fig. 6_Healthy soft tissue conditions one year post grafting. Fig. 7_Virtual placement of a 4.8 mm x 13 mm OsseoSpeed EV implant. Fig. 1 Challengingmulti-disciplinary approach to a damaged tooth in the maxilla Author_Dr Michael R. Norton, UK Fig. 5 Fig. 6 Fig. 2a Fig. 2b Fig. 3 Fig. 4 Fig. 7 CBE0414_14-15_Norton 28.11.14 11:34 Seite 1 CBE0414_14-15_Norton 28.11.1411:34 Seite 1