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ePaper created 2016-12-13, 09:04:25 | version 1.38.0
17 3_2016 case report _ aesthetic replacement cross bite occlusion that transitions from normal to cross bite across this particular tooth’s occlu- sal table. Crown and abutment could potentially be subject to occlusal stress due to this transi- tional relationship. A restoration that provides maximum strength was desirable for long-term stability of the restoration. The patient has a thin bio- type 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, facebow transfer, shade taking, bite registration and clinical photography). Prescription to lab was provided ordering a partial denture fabricated from duracetyl resin and to develop a tooth born surgical guide. Lab was in- structed to simulate the extraction site by removing the tooth from the study cast provided. This model was duplicated for fabrication of the two appliances. Laboratory product was provided to surgeon. Atraumatic extraction was accomplished and immediate implant (Legacy Three, Implant Direct) placed with facial bone grafting (Figs 2-3). There was a healing screw placed and site was closed with appropriate membrane and su- turing techniques. The unilateral partial was not delivered at time of surgery. Patient was seen in restorative office and the partial (Duratek, Drake Precision Laboratories) was modified to provide tissue support and begin development of an ovate tissue site. Partial was delivered unevent- fully. These appliances are extremely retentive and not subject to dislodgement or pressure over the implant site during function. Patient was seen at one week for postoperative check and adjustment of temporary appliance (Fig. 4). Patient was instructed to return to surgical clinic in approximately four months for final evaluation prior to restorative procedures. Four months after surgery, the patient was seen by surgeon to uncover the implant, remove Fig. 4 Fig. 6 Fig. 8 Fig. 5 Fig. 7 Fig. 9 Fig. 4_Temporary Duratek partial. Fig. 5_Healed implant site with healing abutment. Fig. 6_Well-healed mucosa. Fig. 7_Placement of impression coping. Fig. 8_Final PVS impression. Fig. 9_Crown and abutment on analogue model.