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ePaper created 2015-08-28, 13:01:48 | version 1.38.0
I case report _ implant treatment Fig. 1a_Initial situation before extraction. Fig. 1b_Extraction sockets immediately after extraction. Fig. 2_Soft-tissue quality and anatomy after extraction. _Tooth mobility is a clinical finding that indi- cates several difficulties regarding the treatment possibilitiesofthepatientsaffected.Regardlessofthe mobility’scause,periodontaldisease,occlusaltrauma oracombination,theprostheticrehabilitationofsuch patientsischallenging.Asthiscasereportshows,con- ventionalsingle-unitprostheses,suchasfull-ceramic crowns, may solve the aesthetic problems. The aes- thetic outcome may be satisfactory at the beginning, but in the medium term the soft tissue will continue toretract.Atthesametime,themainproblemwillnot havebeenresolved.Mobility,especiallyincasesofun- treated periodontal disease, will proceed despite the prostheses, which will eventually lose functionality, and a new treatment plan will be needed. Periodontal treatments have priority over every other treatment. Depending on the attachment loss, toothmobilitycanpersist,requiringalong-termsta- bility solution. In this case report, the clinical exami- nation found a tooth mobility of Grade II for teeth #12–23 as a result of an attachment loss that per- sistedevenaftersuccessfulconservativeperiodontal treatment.Asmentioned,fixedprosthesesarenotan alternative, and fixing the teeth with a bridge would only accelerate further attachment loss, although it wouldreducetheocclusalload.Aremovabledenture was not an option for the patient. An implant solu- tionwasthusdeemedtheonlyacceptabletreatment. Aremovabletemporarydenturewasnotanoptionfor usandthereforewedecidedtoreplaceeachextracted tooth with an implant with immediate loading. In such cases, surgeons have to deal with tooth loss, epithelial proliferation, bone resorption and loss of the periodontal ligament. In this case, we could clearly see in the pretreatment analysis that major bone resorption had occurred both horizontally and vertically. The bony defects affected more than one wall,buttheboneresorptionaroundtherootwasnot infiltrated with soft tissue. _Clinical and radiographic findings Theclinicalexaminationfoundsevereperiodontal defects with a screening index of Grade IV, pocket depths up to 4mm and tooth mobility. The function- ality was very limited and the aesthetic situation unsatisfactory. The radiographic findings confirmed that all four maxillary incisors and the left canine needed to be extracted (Figs. 1 & 2). The patient had a low scalloped gingiva with a middle thick gingival biotype, rectangular teeth and a bright smile. _Treatment plan A removable denture was not acceptable, nor was a temporary or definitive denture. Although the Non-compromised aesthetics with multiple single implants in the anterior maxillae Authors_Dr Nikolaos Papagiannoulis & Dr Marius Steigmann, Germany 34 I cosmeticdentistry 2_2015 Fig. 1b Fig. 1a Fig. 2