Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-06-01, 10:23:49 | version 1.38.0
implants 2_2016 I C.E. article_ esthetic replacement of maxillary premolar Author_Larry R. Holt, DDS, FICD Esthetic replacement of maxillary premolar with immediate implant placement and metal ceramic crown over CAD/CAM abutment This article qualifies for C.E. credit. To take the C.E. quiz, log on to www.dtstudyclub. com. Click on ‘C.E. articles’ and search for this edition (Implants C.E. Magazine — 2/2016). If you are not regis- tered with the site, you will be asked to do so before taking the quiz. You may also access the quiz by using the QR code below. _c.e. credit part I 04 I _This article describes treatment to solve a com- mon dental complication (loss of tooth due to verti- cal root fracture). Contemporary implant therapy and subsequent CAD/CAM laboratory procedures provide an elegant solution to this patient’s dental emergency. Treatment was accomplished during a periodofapproximatelysixmonths. The patient is a healthy, 52-year-old female with an unremarkable medical history. Her dental history and general dental health are excellent. Unfortu- nately, she suffered a vertical fracture of tooth #5, whichnecessitateditsextraction(Fig.1). The treatment plan was for extraction and im- mediate implant placement with concurrent bone graftingasrequired.Atemporarypartialwasplanned to provide esthetic replacement and to support and shape tissue during the healing process. Final resto- rationwastobeacementedPFMcrownsupportedby anAtlantisgoldhueabutment. Material selection was based on patient’s cross bite occlusion that transitions from normal to cross bite across this particular tooth’s occlusal table. Crown and abutment could potentially be subject to occlusalstressduetothistransitionalrelationship. A restoration that provides maximum strength was desirable for long-term stability of the restora- tion. The patient has a thin biotype, and the gold hue abutment provides both strength and the gold color that provides a more natural tissue color.1 The gold color provides ”warmth” of color in the critical transmucosal region. Titanium abutments provide strength but can telegraph a greying affect on thin tissues. Treatment began with a preoperative appoint- ment to take necessary records (impressions of both arches,facebowtransfer,shadetaking,biteregistra- tionandclinicalphotography). Prescriptiontolabwasprovidedorderingapartial denture fabricated from duracetyl resin and to de- velopatoothbornsurgicalguide.Labwasinstructed tosimulatetheextractionsitebyremovingthetooth from the study cast provided. This model was dupli- catedforfabricationofthetwoappliances. Laboratory product was provided to surgeon. Atraumaticextractionwasaccomplishedandimme- diate implant (Legacy Three, Implant Direct) placed withfacialbonegrafting(Figs.2-3). There was a healing screw placed and site was closed with appropriate membrane and suturing techniques. The unilateral partial was not delivered at time of surgery. Patient was seen in restorative office, and the partial (Duratek, Drake Precision Laboratories)wasmodifiedtoprovidetissuesupport Fig. 1_Fractured tooth. (Photos/Provided by Dr. Larry R. Holt) Fig. 2_Immediate implant placement. Fig. 1 Fig. 2