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CAD/CAM - international magazine of digital dentistry

implantwassealedwithacoverscrew,thesofttissue sutured and an radiograph taken for checking pur- poses (Fig. 21). _Implant exposure with thickening of the soft tissue In order to ensure successful restoration with the implant,wepaid particular attention to thesoft tissue managementwhenexposingtheimplant.Forthispur- poseweemployedthemodifiedrollflaptechniquefor thickeningofthesofttissue(Fig.22).Usingadiamond drill, the epithelium layer over the implant was re- moved and a pedicle flap prepared vestibularly after palatal preparation, surrounding the de-epithelised tissue with cut-outs for the papillae (Fig. 23). The roll flapswerefolded,pushedintothepreparedtunnel,and afterremovingthecoverscrewa4mmhighhealingcap was inserted into the implant (Fig. 24). We thickened the marginal soft tissue as a matter of principle as it could migrate in the apical direction during remodel- ling. The periimplant tissue restructures itself during insertion of the healing cap or the prosthetic restora- tion and the biological scope develops anew.9 For cost reasonswewereunabletoutilisetheoptionofshaping thesofttissueusingatemporaryimplantcrown. _The prosthetic restoration Fourweeksafterexposure,thetissuewasstableand irritation-free and an impression of the situation was taken.Weremovedthehealingcapandplacedtheim- pression post for the closed tray technique into the implant (Fig. 25). The impression cap was attached to thepostandanimpressionoftheupperjawtakenwith polyether. Once the models had been fabricated and articulated, the dental technician fabricated a cus- tomised zirconium dioxide abutment, bonded to a CAMLOG® Titanium base CAD/CAM. The customised shaping of the crown emergence profile is key to the naturalappearanceofaprostheticreconstruction. A zirconium dioxide cap was fabricated over the hybrid abutment, which was veneered with a glass ce- ramic(Figs.26–28).Onthedayofinsertion,thehealing cap was removed, the implant interface cleaned, and thehybridabutmentinserted(Fig.29).Thesurrounding soft tissue was displaced by the customised crown emergenceprofileintotheshapeoftheplannedemer- gence profile. After approximately 3 minutes the soft tissue had revascularised and was evenly coloured red. Thecrownwasseatedandtheoverallappearance,shape of the tooth, colour and position evaluated critically. Theshapingofthepapillaewasnotyetperfect(Fig.30). Therefore, the positions of the contact points were checked.Theverticaldistancebetweenthecrestalbone andtheapproximalcontactpointstotheadjacentden- talcrownswas4mm.Herewereferredtotheinvestiga- tionsonpapillaeformationbyTarnowetal.foraesthetic interdentalpapillaethatremainstablelong-term.10 case report _ implant restorations I I 29CAD/CAM 3_2015 Fig. 19_Placement of implant shoulder 2 mm below enamel cement margin of adjacent teeth. Fig. 20_Placement of the implant according to the criteria of the aesthetic window. Fig. 21_Anatomical shaping of the emergence profile of the crown. Fig. 22_Preparation of a roll flap by means of palatinal incision. Fig. 23_The flap was folded and pushed into the prepared tunnel using a special instrument. Fig. 24_Insertion of a 4 mm high cylindrical CAMLOG® healing cap, suturing of soft tissue. Fig. 25_Impression four weeks after implant exposure. Fig. 26_The model prior to digitalisation with Scanbody. Fig. 22 Fig. 24Fig. 23 Fig. 19 Fig. 21Fig. 20 Fig. 25 Fig. 26

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