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cone beam – international magazine of cone beam dentistry

technique _ first part of an implant treatment I _Complementary tests 2-Dimaging Panoramic X-rays or retroalveolar radiography make it possible to check the depth of implantable bone in relation to the floor of the nasal cavity, the bone level in relation to that of adjacent teeth and the parallelism of the central incisor and canine. 3-Dimaging 3-D imaging is required to check the vestibular palatal dimensions of the bone crest. There are three possibilities: _thecrestissufficientlywidetotakeanimplantwith- out any bone augmentation; _the crest is narrow, bone augmentation is required prior to siting the implant (Fig. 6); _intermediate situations where the siting of the im- plantwillbeaccompaniedeitherbybonesplittingor by guided bone regeneration. _Orthodontic preparation When the adjacent teeth present apical conver- gence, the orthodontic preparation should create a mesio-distal dimension at the level of the root that allows the implant to pass with a margin of at least 1mmofbone(Figs.7&8).Wherethereisacontrolat- eral incisor of a normal size, the rule for the ortho- dontististomeasurethewidthofthattoothcarefully and to recreate the same width in the crown of the planned implant. Where the controlateral incisor is riziform,theorthodontistshouldplanthefutureface of the tooth in order to achieve two laterals with the same shape. Diastemas around the riziform tooth make it pos- sibletoachieveasmilethat,intheend,isalmostsym- metrical (Fig. 9). The riziform incisor does not have to beinthecentreofthespacebutshouldbepositioned in such a way that the papillae and the future zenith of the tooth are optimized. The zenith should be lo- cated 0.4mm distal from the centre of the tooth for a lateral incisor, according to Chu et al.9 (Figs. 10a & b). Fig. 11_Cortical graft in place, shaped to support future papillae (case as shown in Fig. 1). Fig. 12_X-ray result, compare with Fig. 6. Fig. 13_Clinical outcome 5 months after the graft. Compare with Fig. 11. Fig. 14_3 mm diameter Nobel Active implant. Figs. 15a & b_Papillary view (b) X-ray view (a), 2 years after the insertion of the implant. I 15cone beam2_2015 Fig. 15a Fig. 15b Fig. 11 Fig. 12 Fig. 13 Fig. 14

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