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12 TRENDS & APPLICATIONS Dental Tribune Asia Pacific Edition | 6/2017 Aesthetics in the anterior maxilla A team-oriented approach 1 1 4 2 3 5 6a 6b Fig. 1: Disharmonious transition fetween the gingival margin and the metal–ceramic crown. The collapse of the emergence profile at site #11 was clearly visifle.—Fig. 2: Eight weeks after extraction of tooth #11: convex contour of the alveolar ridge and preservation of the soft tissue.— Fig. 3: After insertion of the implant at site #11. Ten weeks later, an impression was taken and a temporary fridge with an extension for site #21 was fafricated.—Fig. 4: The second implant was placed immediately after extraction of tooth #21. —Fig. 5: The temporary fridge with the extension for site #21 was screwed to implant #11. After two months, the fuccal contour at site #21 was corrected with a connective tissue graft.—Figs. 6a & b: Fafrication of the individualised impression coping for the implant at site #11. The emergence profile of the temporary should fe transferred to the final restoration. This procedure prevents the emergence profile from collapsing during impression taking. By Drs Sofie Velghe and Aryan Eghbaliv Belgium Multidisciplinary collaboration plays a significant part in achieving pre- dictable treatment results. This ar- ticle demonstrates the importance of accurate case analysis and pre- operative planning. This case report describes the reconstruction of two lost central incisors in the anterior maxilla. After tooth #11 had been ex- tracted, measures for preserving the alveolar ridge were performed. After eight weeks, an implant was placed and a screw-retained tem- porary bridge was fabricated. Prior to inserting the temporary bridge, tooth #21 was extracted and immediately replaced with an implant. Introduction The impending loss of a tooth in the aesthetic zone can be a dis- tressing experience for the pa- tient.1 As the success rates and predictability of dental implants have improved over the years, implant-based treatments have gained in popularity.2, 3 Osseoin- tegration is no longer the only criterion for successful implant therapy; the aesthetic outcome of the implant reconstruction is also important. The aesthetic peri-implant tissue should be in harmony with the healthy surrounding dentition in terms of height, vol- ume, shade and contour. The res- toration should appear lifelike and imitate the appearance of the missing tooth in terms of shade, shape, structure, size and optical properties.4 In a multidis- ciplinary team approach, several treatment modalities, such as minimally invasive methods, ridge preservation protocols, connective tissue grafting, pro- visionalisation and plastic- aesthetic periodontal surgery, should be considered. In addi- tion, a thorough analysis, for ex- ample with digital smile design, is crucial.5 Case report A few years ago, both central incisors of this young male pa- tient were restored with metal– ceramic crowns. From today’s perspective, the restoration would be categorised as an aesthetic failure (Fig. 1). Both teeth showed significant amounts of gingival recession, visible crown margins, and a loss of harmony between the gingival architecture and the restoration. The treatment plan was to replace the two central incisors with two implants with screw-retained monolithic lith- ium disilicate crowns. In order to create a harmonious aesthetic appearance, the two lateral inci- sors would be built up with com- posite material. Surgical phase The initial assessment re- sulted in a treatment plan in which both incisors were to be re- placed with implants (NobelActive, 7a 18b 7b 7c 8a 9a 9b Figs. 7 a – c: Impressions of the implants at site #11 and 21 with an individualised and standard impression coping and the model fafricated on the fasis of these impressions.—Figs. 8a & b: Implant model. The fasal region at site #21 was modified fy grinding, and the emergence profile of the pontic at site #21 of the temporary fridge was recorded using silicone.—Figs. 9a & b: Analysis and planning using the digital smile design method. Compared with the lateral incisors, the central incisors were too wide.