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ePaper created 2015-06-05, 15:15:11 | version 1.38.0
I case report Fig. 1_The X-ray shows progressive horizontal and vertical bone resorption. Fig. 2_The too long gingiva shield contributes to resorption due to the rotational freedom of the flipper. Fig. 3_To avoid further traumatisation of the soft tissue, the flipper shield was shortened. Fig. 4_The occlusal top view shows the horizontal hard and soft tissue deficit in the implant region. _The demands of treatment with implants are high,particularlyintheaestheticallyrelevantareas.In the case of difficult morphological conditions, the in- dividualwishesofpatientsregardingtheirnaturalap- pearance represent a major challenge for the treat- ment team. A host of materials and techniques for crowns and abutments allow for perfect imitation of the tooth structure. However, aesthetic restoration is only successful if a natural periimplant hard and soft tissue profile can be preserved or reconstructed. The following case study illustrates the complexity of im- plant treatment for combined horizontal and vertical boneresorptionafterthetraumaticlossoftheleftcen- tralincisor. _Dental history and treatment plan Themostpredictable,stablelong-termaestheticre- sultsareachievedthroughasynergisticprocessfordi- agnosis and therapy involving the various dental spe- cialties. Science-based therapies need to be imple- mented with surgical and prosthetic precision and re- quire the active participation of the patient both dur- ingandaftertreatment.A29-year-oldpatientwasre- ferredtoouroralsurgerypracticewiththerequestfor implanttherapyintheanteriormaxilla.Hehadlostthe upper left incisor in an accident some months before. Thegaphadbeentreatedwithaflipperbythereferring dentist. The removable restoration strongly affected thesocialwell-beingoftheyoungman. Examinationshowedadvancedhorizontalandver- ticalboneresorption(Fig.1).Anextendedplasticshield on the flipper was to visually compensating for bone loss(Fig.2).Thisuntowarddesignoftheflipperexerted continuouspressureonthealveolarridgeowingtothe rotary freedom around the clamping axis, particularly during removal but also during chewing motions. The Thechallengeofaesthetic implantrestoration Authors_Dr Jan Spieckermann & Jörg Wildenhain, Germany 06 I implants2_2015 Fig. 1 Fig. 2 Fig. 3 Fig. 4