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today Yankee Dental Congress Boston Jan. 30, 2016

By Timothy Kosinski, DDS, MAGD n Maxillary lateral incisor agenesis (MLIA) is a congenital condition in whichatleastoneofthemaxillarylat- eralincisorsismissingintheprimary or permanent dentition. MLIA occurs in the smile zone and affects esthet- ics and function.1,2 Although MLIA may present challenges because of limited space, implant therapy has becomeoneoftheprimaryoptionsfor addressing it.3 For patients with MLIA, implant therapy is a conservative approach that avoids damage to the neighbor- ing dentition.1 Treatment is relatively noninvasive because adjacent teeth do not need to be prepared. If there is not enough room for an implant, it is possible to create space through orthodontics.4 The following case summary dem- onstrates implant placement in a 20-year-old female who presented with an acid-etch bridge used to restore her missing maxillary right lateral incisor. Although esthetic, the bridge fell off periodically. Because of problems with long-term retention, the acid-etch bridge is not considered a viable permanent solution.5 The patient was interested in implant treatment. The Hahn™ Tapered Implant System (Glidewell Direct; Irvine, Calif.) was utilized to restore the missing tooth. A cement- retained BruxZir® Anterior crown provided a strong, esthetic final result. Case summary The patient presented with a cuspid and central incisor that were mini- mally prepared to support an acid- etch bridge. The bridge was esthetic, but the patient was concerned about long-term function (Fig. 1). The lateral incisor site can present difficulties when surgically plac- ing dental implants. Radiography indicated, however, that there was enough space for an implant. Scans were taken using the PaX-i3D Green imaging system (VATECH America Inc.; Fort Lee, N.J.). Because the patient’s anatomy did not present any complications, the implant was placed freehand. The diameter of the osteotomy was slightly smaller than that of the implant chosen for this case, and a depth of approximately 13 mm was established. A 3-mm-diameter Hahn Tapered Implant was utilized. The diameter size and tapered body of the implant was ideal for the limited space. The implant features prominent threads, which eases placement and allows the clinician to thread the implant into an undersized osteotomy. The abilitytoplaceanimplantinaslightly smaller osteotomy can help ensure excellent primary stability.6 A cover screw was hand-tightened into the implant. The patient’s acid- etch bridge was cemented back onto the adjacent teeth and functioned as a transitional appliance during heal- ing. Four months following surgery, the patient returned to begin the restorative process (Fig. 2). A tissue punch was utilized to access the healed implant site. Panasil® vinyl polysiloxane mate- rial (Kettenbach; Huntington Beach, Calif.) was used to create a final impression. The dental lab fabricated an Inclusive® Titanium Custom Abut- ment and a BruxZir Anterior crown. Because the patient could only return to the dental office during school breaks, she again used the bridge as a transitional prosthesis. At the final delivery appoint- ment, the custom implant abutment was placed and the final crown was cemented on the custom abutment. The patient was pleased to have a fixed restoration that exhibits high stability, strength and esthetics (Fig. 3). Conclusion Implant treatment proved to be an outstanding treatment modality in a difficult situation. The Hahn Tapered Implant allowed for surgical predict- ability and reliable osseointegration. References 1. Núbia Inocencya Pavesi Pini, Luciana Manzotti De Marchi, Renata Correa Pascotto. Congeni- tally Missing Maxillary Lateral Incisors: Update on the Func- tional and Esthetic Parameters of Patients Treated with Implants or Space Closure. Open Dent J. 2014; 8:289-294. 2. Willhite C, Bellerino M, Eubanks J. Treatment of Congenitally Missing LateralIncisorswithResin-Bonded Fixed Partial Dentures. Quintes- sence Dent Technol. 2002:63-72. 3. Richardson G, Russel, KA. Congen- itally Missing Maxillary Lateral Incisors and Orthodontic Treat- mentConsiderationsfortheSingle- Tooth Implant. J Can Dent Assoc 2001;67:25-8 4. Ashutosh Nirola, Shallu J. Bhard- waj, Anuj Wangoo, and Amardeep Singh Chugh. Treating congeni- tally missing teeth with an inter- disciplinaryapproach.JIndianSoc Periodontol. 2013 Nov-Dec; 17(6): 793-795. 5. El-Mowafy OM. Posterior acid- etch bridge--a modified retentive design.JCanDentAssoc.1996Nov; 62(11):862-865. 6. Degidi M, Daprile G, Piattelli A. Influence of underpreparation on primary stability of implants inserted in poor quality bone sites: an in vitro study. J Oral Maxillofac Surg. 2015 Jun; 73(6):1084-1088. exhibitors 10 Yankee Dental Congress — January 30, 2016 Optimizing lateral incisor function and esthetics with the Hahn implant system 5 Fig. 1: Though the bridge was esthetic, it would come loose, causing the patient to worry about its long-term function. (Photos/Provided by Glidewell Laboratories) 5 Fig. 2: Full osseointegration was achieved four months after implant placement. 5 Fig. 3: The final restoration exhibits lifelike translucency. Here at Yankee To learn more about the Hahn Tapered Implant, stop by the Glidewell Labora- tories booth, No. 1600. Taking Planmeca FIT to the next power By Planmeca Staff n The Planmeca FIT™ system for chairside CAD/CAM dentistry pro- vides clinics with a completely digital workflow from start to finish. It seam- lessly integrates intraoral scanning, 3-D designing and on-site milling into one system, allowing clinics to produce restorations in a single visit. Scanning with the system is now faster than ever before, with color scanning featured for the first time. The Planmeca FIT system is com- posed of the Planmeca PlanScan® scanner, the Planmeca PlanCAD® Easy software and the Planmeca Plan- Mill® 40 milling unit, enabling dental clinics to create high-quality restora- tions that fit perfectly. The Planmeca FIT system has made strides lately in both scanning speed and accuracy, according to the com- pany. Intraoral scans can now be performedupto40percentfasterthan before. Furthermore, the system has been improved with color scanning capa- bility. This provides several benefits. Color scans enhance diagnostics, as they make it easier to differentiate between soft and hard tissues. Color scans also improve communication and increase case acceptance, as they are easier for patients to comprehend. Here at Yankee TolearnmoreaboutPlanmecatechnol- ogy, visit booth No. 1831. 5 (Photo/Provided by Planmeca)

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