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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
| CE article aesthetic replacement of premolar Aesthetic replacement of maxillary premolar with immediate implant placement and metal ceramic crown over CAD/CAM abutment Author: Dr Larry R. Holt, USA CE credit This article qualifies for CE cred- it. To take the CE quiz, log on to www.dtstudyclub.com. Click on ‘CE articles’ and search for this edition of the magazine. If you are not registered with the site, you will be asked to do so before tak- ing the quiz. This article describes treatment to solve a common dental complication (loss of tooth due to vertical root fracture). Contemporary implant therapy and subse- quent CAD/CAM laboratory procedures provide an elegant solution to this patient’s dental emergency. Treatment was accomplished during a period of approximately six months. The patient was a healthy, 52-year-old female with an unremarkable medical history. Her dental history and general dental health were excellent. Unfortu- nately, she suffered a vertical fracture of tooth #5, which necessitated its extraction (Fig. 1). Fig. 1: Fractured tooth. Fig. 2: Immediate implant placement. Fig. 3: Bone grafting and membrane placement. The treatment plan was for extraction and imme- diate implant placement with concurrent bone graft- ing as required. A temporary partial was planned to Fig. 1 provide aesthetic replacement and to support and shape tissue during the healing process. A final res- toration was to be a cemented PFM crown supported by an Atlantis gold hue abutment. Material selection was based on the patient’s crossbite occlusion that transitions from normal to crossbite across this particular tooth’s occlusal table. Crown and abutment could potentially be subject to occlusal stress due to this transitional relationship. A restoration that provides maximum strength was desirable for long-term stability of the restoration. The patient has a thin biotype; the gold hue abut- ment provides both strength and the gold colour pro- vides a more natural tissue colour.1 The gold colour provides “warmth” of colour in the critical transmu- cosal region. Titanium abutments provide strength but can telegraph a greying effect on thin tissues. The treatment began with a pre-operative appoint- ment to take necessary records (impressions of both arches, facebow transfer, shade taking, bite registra- tion and clinical photography). Fig. 2 Fig. 3 32 CAD/CAM 2 2017