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ePaper created 2015-05-29, 13:18:43 | version 1.38.0
case report _ CBCT in diagnosis I regions #12 and 22, while aligning the apices of the adjacent teeth. CTscananalysisandchoiceofimplants TheCTscancross-sectionsofregions#12and22 showed a limited bone volume on the vestibulo- palatal plane, which would not have allowed for standard-diameter implants to be placed without the use of a bone augmentation technique. The cortical bone, however, was preserved (Figs. 3a–4). Narrow implants (Axiom 2.8, Anthogyr) were used for this restoration. Axiom 2.8 has been de- signed exclusively to replace mandibular incisors and maxillary lateral incisors. It is equipped with a three-degree Morse taper connection system with an integrated switching platform. The special fea- ture of the system is that the abutment is impacted withoutatransfixationscrew.Abutmentsareavail- able in several gingival heights and angulations, making Axiom 2.8 adaptable for any prosthetic situation. Placingtheimplantsandfabricatingtheprostheses Placementoftheimplantsinregions#12and22 was done during the same procedure. Under local anaesthesia, two 2.8 mm x 10 mm implants were placed 0.5 mm sub-crestally (Figs. 5a–d). Very light drilling enabled bone condensation of the specific sites.Thecorrect3-Dpositioningoftheimplantwas vitalforthefinalaestheticresult.Temporarycrowns were attached to the orthodontic arch wire and left inplaceforthethreemonthsofosseointegrationin order to ensure post-orthodontic fixation of the teeth. Threemonthspostoperatively,thepatient’sbrack- ets were removed by the orthodontist and the tem- porarycrownsfabricateddirectlyonthePEEKhealing plugs (Fig. 6). The basal surface of the temporary crowns was carefully polished. After a period of two months of gingival matu- ration, which was put to good use by performing dental whitening in an outpatient setting, the prosthetic phase could begin. The implant impres- sions were taken with the pop-in technique (Fig. 7) using an individual impression tray fabricated in the laboratory. The choice of the most suitable abutment by means of the planning kit by the laboratory was a vital step. In fact, the abutments required only very slight adjustments or none at all. Having the option of four gingival heights and four angulations enabled us to adapt to any clini- cal situation. The laboratory prepared the metal–ceramic crowns(Figs.8a–9).Theprostheseswereverifiedin the mouth and then the crowns were fixed to the abutment with Fuji PLUS cement (GC) outside of the mouth (Figs. 10–13b). This allowed for perfect control of excess cement and guarded against any risk of gingival inflammation. The abutment together with the crown was im- pacted with the Safe Lock system, mounted on the chair unit. The Safe Lock system made it possible to control the impaction. The recommended five impactions were applied to seat the prostheses permanently(Figs.10–13b).Thegoodaestheticre- sults were related to the symmetry of the emer- genceprofiles.Thenarrowdiameteroftheimplant was perfectly adapted to this clinical situation. Fig. 4_3-D reconstruction of the CT scan cross-sections of the premaxillary zone. The high concavity of the vestibular cortical plates can be observed in regions #12 and 22. Figs. 5a–d_Pre- and post-op radiographs of regions #12 and 22. Fig. 6_The temporary crowns were fabricated on PEEK healing plugs. I 21cone beam2_2015 Fig. 4 Fig. 5a Fig. 5b Fig. 5c Fig. 5d Fig. 6