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implants - international magazine of oral implantology

implantwassealedwithacoverscrew,thesofttissue sutured and an radiograph taken for checking pur- poses (Fig. 21). _Implant exposure with thickening of the soft tissue In order to ensure successful restoration with the implant, we paid particular attention to the soft tissue managementwhenexposingtheimplant.Forthispur- poseweemployedthemodifiedrollflaptechniquefor thickeningofthesofttissue(Fig.22).Usingadiamond drill, the epithelium layer over the implant was re- moved and a pedicle flap prepared vestibularly after palatal preparation, surrounding the de-epithelised tissue with cut-outs for the papillae (Fig. 23). The roll flapswerefolded,pushedintothepreparedtunnel,and afterremovingthecoverscrewa4mmhighhealingcap was inserted into the implant (Fig. 24). We thickened the marginal soft tissue as a matter of principle as it could migrate in the apical direction during remodel- ling. The periimplant tissue restructures itself during insertion of the healing cap or the prosthetic restora- tion and the biological scope develops anew.9 For cost reasonswewereunabletoutilisetheoptionofshaping thesofttissueusingatemporaryimplantcrown. _The prosthetic restoration Fourweeksafterexposure,thetissuewasstableand irritation-free and an impression of the situation was taken.Weremovedthehealingcapandplacedtheim- pressionpostfortheclosedtraytechniqueintotheim- plant (Fig. 25). The impression cap was attached to the post and an impression of the upper jaw taken with polyether.Oncethemodelshadbeenfabricatedandar- ticulated, the dental technician fabricated a cus- tomised zirconium dioxide abutment, bonded to a CAMLOG® Titanium base CAD/CAM. The customised shaping of the crown emergence profile is key to the naturalappearanceofaprostheticreconstruction. Azirconiumdioxidecapwasfabricatedoverthehy- bridabutment,whichwasveneeredwithaglassceramic (Figs. 26–28). On the day of insertion, the healing cap wasremoved,theimplantinterfacecleaned,andthehy- brid abutment inserted (Fig. 29). The surrounding soft tissue was displaced by the customised crown emer- genceprofileintotheshapeoftheplannedemergence profile. After approximately 3 minutes the soft tissue had revascularised and was evenly coloured red. The crownwasseatedandtheoverallappearance,shapeof the tooth, colour and position evaluated critically. The shaping of the papillae was not yet perfect (Fig. 30). Therefore, the positions of the contact points were checked.Theverticaldistancebetweenthecrestalbone andtheapproximalcontactpointstotheadjacentden- talcrownswas4mm.Herewereferredtotheinvestiga- tionsonpapillaeformationbyTarnowetal.foraesthetic interdentalpapillaethatremainstablelong-term.10 case report I I 11implants2_2015 Fig. 19_Placement of implant shoulder 2 mm below enamel cement margin of adjacent teeth. Fig. 20_Placement of the implant according to the criteria of the aesthetic window. Fig. 21_Anatomical shaping of the emergence profile of the crown. Fig. 22_Preparation of a roll flap by means of palatinal incision. Fig. 23_The flap was folded and pushed into the prepared tunnel using a special instrument. Fig. 24_Insertion of a 4 mm high cylindrical CAMLOG® healing cap, suturing of soft tissue. Fig. 25_Impression four weeks after implant exposure. Fig. 26_The model prior to digitalisation with Scanbody. Fig. 22 Fig. 24Fig. 23 Fig. 19 Fig. 21Fig. 20 Fig. 25 Fig. 26

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