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cosmetic dentistry_ beauty & science

I case report _ implant treatment 36 I cosmeticdentistry 2_2015 major focus of treatment was on functional reha- bilitation, aesthetics should not be underestimated in such cases. Once functionality has been obtained, thepatient’sattentionturnstohisorherappearance. Thepatientwastoreceiveimplantsforteeth#12–23 in an immediate implantation with simultaneous guided bone regeneration. The implants were to be loaded immediately with a high-filler resin tempo- rary bridge. _Surgery Withawax-uponthesituationmodel,anoptimal form was created to support and manipulate soft tissue during the healing phase. At the same time, the temporary bridge functions as wound coverage if primary closure is not possible (Figs. 3–6).1–4 In the next step, teeth #12–23 were extracted. The flap outline preserved the papillae of the adja- cent teeth by an incision at the papilla base. Owing to the interproximal bone defects, papilla raising in this region would have led to severe recession. The vertical bone defects were obvious after raising a full-thickness flap. A releasing incision was made only mesiodistally at tooth #12 and only in attached gingiva to prevent scar formation through vertical cuts at the mucosa. The low vestibule made a split- thickness or periosteal pocket flap the less logical choice. Mobilising soft tissue from the lips too, throughotherflapdesigns,wouldhavecausedfunc- tional limitations, suture tension and a second gin- gival surgery to reposition the coronally transposi- tioned soft tissue. The wound margins were cut back to remove excess epithelium and the bone defects freed from soft-tissue ingrowth (Figs. 7–10). The horizontal bone loss was moderate. The im- plants were placed slightly sub-crestally. Although the gap between the implants and buccal plate was duetotheresorptionofapproximately1–1.5mmand the buccal plate thickness of less than 1 mm, we decided on 3.8mm implants, leaving a 1.5mm gap from the buccal plate.5–10 The inter-implant space and the buccal plate were augmented with a combination of allograft and xenograft materials. Autologous bone obtained with a bone scraper was placed directly on the im- plantsurfaceandcoveredwithamixtureofallograft and xenograft materials. A pericardium membrane was used as barrier (Fig. 11). Fig. 3_Flap raising and implant insertion, showing the bone morphology after extraction. Fig. 4_Implant positioning, frontal view. Fig. 5_Guided bone regeneration: filling the gap to the buccal plate and the interproximal space. Fig. 6_Flap closure, coronal view. Fig. 7_Flap closure, frontal view. Fig. 8_Provisorium and temporary bridgework. Fig. 3 Fig. 4 Fig. 6Fig. 5 Fig. 8Fig. 7

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