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ePaper created 2016-03-11, 23:13:06 | version 1.38.0
24 — issue 2016 Advanced Implant Esthetics Article epithelial junction forms, and the under- lying connective tissue subsequently sta- bilizes. The abutment material may influ- ence cellular attachment processes.22–24 Surface contamination occurring after laboratoryorclinician manipulation orre- use of the abutments has been shown to have a detrimental effect on cellular at- tachment.25, 26 Multiple protocols, includ- ingrinsingwithsalinesolutionorhydrogen peroxide,27 autoclave sterilization28 and ultrasonictreatment,25 havebeendevised to restore the original biocompatible abutment surface composition without changing the surface topography. Most havefailedtoeliminatethecontaminants, and some have worsened the cell adhe- sion.28, 29 However, exposure to ozone has been demonstrated to eliminate plaque film completely,27 and the ability of chlorhexidine to decontaminate abut- ment surfaces has also been demon- strated.30 Providing a biocompatible en- vironment before abutments are placed Fig.2 Fig.3 Fig.4 Fig.5 Fig.6 Fig.7 Fig.8 Fig.9 Fig.10 Fig. 2 The patient was a 29-year- old woman who presented with pain in her maxillary central incisors. Fig. 3 Radiographic examination revealed the presence of periapical lesions. The teeth were deemed to be non- restorable. Fig. 4 The central incisors were atraumatically extracted, and the sockets were imme- diately filled with collagen sponges to aid with clot sta- bilization. Fig. 5 The patient returned five weeks after the extractions for early placement of im- plants. Fig. 6 Reflection of a flap re- vealed the absence of the labial bony plate. Osteot- omies were created, and two 3i T3 Tapered Implants, both 4 mm in diameter and 13 mm in length with a 3.4 mm platform, were placed. Fig. 7 Good primary stability was obtained for both implants, but large labial defects were present, as demonstrated by this occlusal view. Im- pressions were taken imme- diately after implant place- ment in order to prepare the definitive prosthetic abutment. Fig. 8 Along with implant place- ment, guided bone regener- ation was carried out using Endobon Xenograft Gran- ules and an OsseoGuard Membrane (BIOMET 3i). A connective tissue graft was also performed. Fig. 9 Occlusal view after implant placement and grafting. Fig. 10 Three months after place- ment of the implants, the provisional prostheses were removed. The shape of the soft tissue was progres- sively modified to improve the emergence profile and to expose the cover screws in a nontraumatic second surgery (soft-tissue remod- eling technique). Article_Vela_00-00.qxp_Layout 1 02.03.16 20:54 Seite 3 Article_Vela_00-00.qxp_Layout 102.03.1620:54 Seite 3