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implants - international magazine of oral implantology

case report I bone loss or recession. Any other procedure would have led to a two-stage surgical approach and prob- ably to a removable prosthesis. The patient’s thick biotype, particularly the low lip line, was very favourable. The quantity of soft tissue was evident. Tension on the flap closure was pre- ventedthroughthesurgicalprotocolandfreegranu- lation of the wound. The bone quantity ensured primary stability of the implant. The immediate im- plantation provided stability for the augmentation andreducedtheamountofmaterialrequired.Thepo- sitioning of the implant allowed us to create an opti- mal emergence profile, making complicated soft- tissue procedures unnecessary.17–19 Through the positioning of the implants and the free granulation of the extraction wound, we en- hanced the soft tissue, a major advantage for the re- entry and prosthesis.20–22 Theimplantsplacedhavemicrogroovesof1mmin height on the implant neck. This laser-manufactured design imitates biology and promises improved cell adhesion to this surface. Such modern designs, com- bined with the advantages of platform switching, re- sult in high-tech products. Modern crestal bone maintenanceworksbymeansoftheprotectionofthe crestal bone. When implants are placed sub-crestally or crestally, a soft-tissue ring is built up on the plat- form to protect the bone below. When implants are placed supra-crestally, the implant neck designs se- cure the crestal bone below through soft-tissue fibre attachment to their necks, implants can be placed closertoeachother,caseslikethiscanbetreatedsuc- cessfully with single implants, and fibre attachment to the surface and between the implants secures the crestal bone, building a natural barrier.23,24 Incasesinwhichprimaryclosureisnotpossibleor mobilisation of adjacent soft tissue through other flap designs is not desired, temporary prostheses are essential. The soft-tissue manipulation begins from the very first moment and is crucial for the aesthetic outcome.25–27 Owingtotheimplantsusedandtheim- mediateloading,thesofttissuedidnothavetobema- nipulated. The implant system allowed us to take the impressions without having to remove the abut- ments. The continuous removal and insertion of im- plant components may introduce bacteria under the soft tissue. Every aesthetic try-in could also be per- formed on the initial abutments. In this protocol, we only removed the temporary abutments once the fixed single-unit crowns had been fabricated. The clinical situation at the point of implant load- ingwiththecrownsshowedoptimalsoft-tissuequal- ity and quantity. No individual abutments were needed. The aesthetic achieved was more than satis- factory, especially regarding the soft-tissue out- come.13–15 The combination of these biomaterials forms part of our standard augmentation protocol and is well documented.Theresultsofguidedboneregeneration are predictable and can be planned, even in case of major defects. The structure of the combined bioma- terialsisveryimportant.Rockyandedgyparticleshelp toestablishinternalstabilisationattheaugmentation area. Often, external stabilisation with pins or screws isunnecessary.Theporosityoftheparticlesisdefined bytheirbiology.Thisisthereasonthatwedonotpre- feralloplasticbiomaterialsandtakeadvantageofthe benefits of allografts and xenografts through their combination. These are the requirements of modern biomaterials, including of course osteoinductivity and osteoconductivity.28–30 _Conclusion Periodontal disease is frequently a limiting factor inoralimplantology,buttherearesituationsinwhich periodontaldiseasepresentsnocontra-indicationfor implantology.Prerequisitesforsimilarproceduresare an understanding and knowledge of biology, surgery andprosthetics.Therearenoalgorithmsforsuchpro- cedures, rather the treatment outcome depends on proper diagnosis, analysis and planning for every in- dividualpatientandtheselectionoftherightimplant system and biomaterials. As the presented case has shown,modernimplantologyprovidesallofthetools for successful implant treatment._ Fig. 15_Radiographic control immediately after loading. Fig. 16_Radiographic control one year after loading. I 11implants1_2015 contact Dr Nikolaos Papagiannoulis Dental Esthetics www.fsde.com.gr Dr Marius Steigmann Steigmann Implant Institute www.steigmann-institute.com Fig. 15 Fig. 16

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