Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-08-28, 13:01:48 | version 1.38.0
case report _ implant treatment I further bone loss or recession. Any other procedure wouldhaveledtoatwo-stagesurgicalapproachand probably to a removable prosthesis. The patient’s thick biotype, particularly the low lip line, was very favourable. The quantity of soft tissue was evident. Tension on the flap closure was pre- vented through the surgical protocol and free gran- ulation of the wound. The bone quantity ensured primary stability of the implant. The immediate im- plantation provided stability for the augmentation and reduced the amount of material required. The positioning of the implant allowed us to create an optimalemergenceprofile,makingcomplicatedsoft- tissue procedures unnecessary.17–19 Through the positioning of the implants and the free granulation of the extraction wound, we enhanced the soft tissue, a major advantage for the re-entry and prosthesis.20–22 Theimplantsplacedhavemicrogroovesof1mmin height on the implant neck. This laser-manufactured design imitates biology and promises improved cell adhesion to this surface. Such modern designs, com- bined with the advantages of platform switching, result in high-tech products. Modern crestal bone maintenanceworksbymeansoftheprotectionofthe crestal bone. When implants are placed sub-crestally or crestally, a soft-tissue ring is built up on the plat- form to protect the bone below. When implants are placed supra-crestally, the implant neck designs se- cure the crestal bone below through soft-tissue fibre attachment to their necks, implants can be placed closertoeachother,caseslikethiscanbetreatedsuc- cessfully with single implants, and fibre attachment to the surface and between the implants secures the crestal bone, building a natural barrier.23,24 In cases in which primary closure is not possible or mobilisation of adjacent soft tissue through other flap designs is not desired, temporary prostheses are essential. The soft-tissue manipulation begins from the very first moment and is crucial for the aesthetic outcome.25–27 Owing to the implants used and the immediate loading, the soft tissue did not have to be manipulated. The implant system allowed us to take the impressions without having to remove the abut- ments. The continuous removal and insertion of implant components may introduce bacteria under the soft tissue. Every aesthetic try-in could also be performed on the initial abutments. In this protocol, we only removed the temporary abutments once the fixed single-unit crowns had been fabricated. Theclinicalsituationatthepointofimplantloading with the crowns showed optimal soft-tissue quality and quantity. No individual abutments were needed. The aesthetic achieved was more than satisfactory, especially regarding the soft-tissue outcome.13–15 The combination of these biomaterials forms part of our standard augmentation protocol and is well documented.Theresultsofguidedboneregeneration are predictable and can be planned, even in case of major defects. The structure of the combined bioma- terialsisveryimportant.Rockyandedgyparticleshelp toestablishinternalstabilisationattheaugmentation area. Often, external stabilisation with pins or screws isunnecessary.Theporosityoftheparticlesisdefined bytheirbiology.Thisisthereasonthatwedonotpre- feralloplasticbiomaterialsandtakeadvantageofthe benefits of allografts and xenografts through their combination. These are the requirements of modern biomaterials, including of course osteoinductivity and osteoconductivity.28–30 _Conclusion Periodontal disease is frequently a limiting factor inoralimplantology,buttherearesituationsinwhich periodontaldiseasepresentsnocontra-indicationfor implantology.Prerequisitesforsimilarproceduresare an understanding and knowledge of biology, surgery and prosthetics. There are no algorithms for such procedures, rather the treatment outcome depends on proper diagnosis, analysis and planning for every individual patient and the selection of the right im- plant system and biomaterials. As the presented case has shown, modern implantology provides all of the tools for successful implant treatment._ Fig. 15_Radiographic control immediately after loading. Fig. 16_Radiographic control one year after loading. I 39cosmeticdentistry 2_2015 Fig. 15 Fig. 16 Dr Nikolaos Papagiannoulis Dental Esthetics www.fsde.com.gr Dr Marius Steigmann Steigmann Implant Institute www.steigmann-institute.com cosmeticdentistry _contact