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ePaper created 2015-08-28, 13:01:48 | version 1.38.0
I case report _ implant treatment Fig. 9_Aesthetics with temporary bridgework. Fig. 10_Soft-tissue healing three months post-op. Fig. 11_Soft-tissue quantity and quality before loading. Fig. 12_Soft-tissue healing, coronal view. Fig. 13_Zirconia abutments before loading. Fig. 14_Fixed single-unit prosthesis. The anatomy of the maxillae and the low vesti- bule did not allow primary closure. To protect the augmentation and the membrane from proteolytic resorption, we placed two layers of collagen tissue fleece above the membrane. Through the collagen fleece and the protection of the provisional bridge, free granulation of the extraction socket was ex- pected after two weeks (Figs. 11 & 12). The patient was recalled weekly for prophylaxis and hygiene instructions. Three weeks post-opera- tively, the sutures were removed. The tissue was not inflamed and the wound healing and closure ideal (Fig. 13). _Re-entry and prostheses Threemonthspost-operatively,animpressionwas taken without removing the abutments using special impressionscrews.Theabutmentswerenotremoved (exceptforphotographs)untilthezirconiaabutments had been fabricated. The healed situation showed optimalsoft-tissuequalityandanadequatequantity of attached gingiva. Above the implant necks, we measured a soft-tissue height of 2–2.5mm, enough for the necessary emergence profile. With the help of convex or concave prostheses, soft tissue can be manipulated in the direction desired for aesthetic reasons (Figs. 15 & 16).13–16 Thefinalcrownsshowedgreatresults.Thepapillae and pseudo-papillae filled the interproximal space. Theinterproximalcontacthadtobedeeperandwider than normal in order to compensate for the previous vertical bone loss, especially in regions #11 and 12. Nevertheless, no black triangles could be seen, the patient was satisfied and it was expected that with the proper hygiene the aesthetic outcome would be optimisedinthenextseveralmonths.Therefore,there was no need to use gingival ceramics. _Discussion In a periodontally compromised situation, it is important to decide whether a curative periodontal treatment offers satisfactory long-term results. As was the case on this occasion, an extraction at the crucial time helps us to preserve what we have, use it to the maximum for implant surgery and risk no 38 I cosmeticdentistry 2_2015 Fig. 13 Fig. 14 Fig. 9 Fig. 10 Fig. 11 Fig. 12