Dental Tribune Pakistan Edition

CLINICAL PRACTICE 2015 Pakistan Edition DENTAL TRIBUNE 5 mild horizontal discrepancy at region #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 the dark aspect of the nearby root of tooth #11 (Figs. 14 & 15). In both surgical appointments, vertical papillary incisions, which had been deemed not necessary, could be avoided. Prosthetic procedures A screw-retained provisional crown remained in situ for six months on the implant while maturation and stabilisation of the peri-implant soft-tissue contours were established. During this period, modifications in form, contour and outline were effected to improve the aesthetic outcome using a light-curing composite material (Fig. 16). Proper implant placement allowed the establishment of an optimal final subgingival contour (Fig. 17). A customis ed impression coping was then fabricated to capture the transition zone contour created by the provisional restoration. For the final restoration, a CAD/CAM zirconia abutment was selected and Straumann CARES CADCAM was used to fabricate the frameworks (Figs. 18 & 19). The screw access position allowed the use of a one-piece restoration. The abutment was veneered using a pressable ceramic system. After the try-in and colour correction by the laboratory, the final crown was delivered to the patient and tightened at 35 N cm. The access hole was sealed with gutta-percha and a light-curing composite resin. The prosthetic procedures on the root of tooth #11 involved the delivery of a longer golden post in order to reduce the risk of root fracture. For the same purpose, it was essential to perform prosthetic preparation of the palatal aspect of the gold abutment to create 1.5–2.0 mm of space for the zirconia framework and pressable ceramic. The final goal was to avoid interference during protrusive movements. Conclusion The surgical and prosthetic challenge in this clinical case was to develop a natural scalloped mucosal line on the maxillary central incisors and to obtain a good aesthetic outcome with the prosthetic crowns, despite the various existing dental and skeletal asymmetries and the bone defects at the implant site. Of utmost importance was knowledge of the hard- and soft-tissue remodelling around the implant in region #21 and around the root of tooth #11 after the surgical steps. A benefit resulting from the conservation of the root of tooth #11 was the maintenance of the interproximal height of the tiny bone peak, which provided support to the papilla mesial to the implant. Furthermore, this approach was highly beneficial to the natural appearance of the prosthetic crowns (Figs. 20 & 21). The periapical radiograph (two-year follow-up) shows the stable crestal bone levels around the implant (Fig. 22). About the Author Riccardo Verdecchia,DMD, maintains a private practice in Rome (Italy) specializing in p e r i o d o n t o l o g y, i m p l a n t dentistryand fixed prosthodontics. He isa member of the InternationalTeam for Implantology andthe Società Italiana di Parodontologia e Implantologia (Italian society of periodontology and implantology). He can be contacted at riccardoverdecchia@hotmail.com. March Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 21 Fig. 22

Dental Tribune Pakistan Edition

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