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ePaper created 2015-03-06, 14:42:46 | version 1.33.01
38 I I case report _ tissue management and CAD/CAM restoration _Procedure Firstsurgicalprocedure Six weeks later, periodontal and implant surgery wereperformed.Amid-crestalincisionwasexecuted on the implant site. At this stage, scalloped incisions wereappliedonthepalatalandbuccalsidesoftooth #11. Afterwards, bucco-oral ostectomies on the root were performed for the previously described goals. The tiny interproximal bone peak was treated with duerespectandleftuntouched(Fig.7).Subsequently, aStraumannBoneLevelimplant(ø4.1mm,SLActive 12 mm) was inserted in the correct 3-D position to replace tooth #21 (Fig. 8). Shortly afterwards, auto- genous bone chips were harvested locally and ap- plied to cover the dehiscence-type defect. A layer of Straumann BoneCeramic (400–700 μm) was placed toovercontourtheexternalsurfaceofthefacialbone. Thegraftingmaterialwascoveredwithanon-cross- linkedcollagenmembraneinaccordancewithguided bone regeneration principles (Fig. 9). A double-layer technique was used to improve the stability of the membrane.Onceperfusedwithblood,themembrane couldbeeasilyadaptedtothealveolarbonecrestand did not require any additional fixation. Tension-free primarywoundclosurewasachievedwithhorizontal mattresssuturesaftersplittingtheperiosteumatthe baseoftheflap(Fig.10).Theovateponticwasground toavoidpressureonthetissuebelow.Theprovisional bridge was then recemented (Fig. 11). Secondsurgicalprocedure The stability of the provisional bridge allowed an extended interval (four months) for the final flattening of the ridge contour due to remodelling of the alveolar bone. A roll flap technique was then regarded as adequate to compensate for a mild horizontaldiscrepancyatregion#21(Figs.12&13). Meanwhile, a very thin (≤ 1 mm) connective tissue graft was harvested from the premolar area of the palate and inserted with a tunnel technique in a supra-periosteal pouch, with the purpose of hiding CAD/CAM 1_2015 Fig. 21Fig. 20 Fig. 22 Fig. 19Fig. 18 CAD0115_36-39_Verdecchia 02.03.15 12:54 Seite 3 CAD0115_36-39_Verdecchia 02.03.1512:54 Seite 3