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implants - international magazine of oral implantology

I case report Fig. 9_Aesthetics with temporary bridgework. Fig. 10_Soft-tissue healing three months post-op. Fig. 11_Soft-tissue quantity and quality before loading. Fig. 12_Soft-tissue healing, coronal view. Fig. 13_Zirconia abutments before loading. Fig. 14_Fixed single-unit prosthesis. Theanatomyofthemaxillaeandthelowvestibule did not allow primary closure. To protect the aug- mentation and the membrane from proteolytic re- sorption, we placed two layers of collagen tissue fleece above the membrane. Through the collagen fleece and the protection of the provisional bridge, free granulation of the extraction socket was ex- pected after two weeks (Figs. 11 & 12). The patient was recalled weekly for prophylaxis and hygiene instructions. Three weeks post-opera- tively, the sutures were removed. The tissue was not inflamed and the wound healing and closure ideal (Fig. 13). _Re-entry and prostheses Threemonthspost-operatively,animpressionwas taken without removing the abutments using special impressionscrews.Theabutmentswerenotremoved (exceptforphotographs)untilthezirconiaabutments hadbeenfabricated.Thehealedsituationshowedop- timalsoft-tissuequalityandanadequatequantityof attachedgingiva.Abovetheimplantnecks,wemeas- uredasoft-tissueheightof2–2.5mm,enoughforthe necessaryemergenceprofile.Withthehelpofconvex orconcaveprostheses,softtissuecanbemanipulated inthedirectiondesiredforaestheticreasons(Figs.15 & 16).13–16 Thefinalcrownsshowedgreatresults.Thepapillae and pseudo-papillae filled the interproximal space. Theinterproximalcontacthadtobedeeperandwider than normal in order to compensate for the previous vertical bone loss, especially in regions #11 and 12. Nevertheless,noblacktrianglescouldbeseen,thepa- tient was satisfied and it was expected that with the properhygienetheaestheticoutcomewouldbeopti- misedinthenextseveralmonths.Therefore,therewas no need to use gingival ceramics. _Discussion Inaperiodontallycompromisedsituation,itisim- portant to decide whether a curative periodontal treatment offers satisfactory long-term results. As wasthecaseonthisoccasion,anextractionatthecru- cial time helps us to preserve what we have, use it to the maximum for implant surgery and risk no further 10 I implants1_2015 Fig. 13 Fig. 14 Fig. 9 Fig. 10 Fig. 11 Fig. 12

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