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ePaper created 2017-08-01, 09:42:24 | version 1.38.0
Dental Tribune Asia Pacific Edition | 6/2017 TRENDS & APPLICATIONS 13 10a 10b 10c 10d 10e 10f 10g 10h 10i 10j 10k 10l 10m 10n 10o Nobel Biocare). In order to main- tain the central papilla between the incisors, a gradual extraction of the two teeth was performed, starting with tooth #11. A few weeks later, tooth #21 was ex- tracted, followed by immediate implant placement. A temporary bridge with an extension as pon- tic #21 was fabricated in order to contour the soft tissue. Figures 2 to 5 show the surgical phase aimed at preserving the soft tissue. Prosthetic phase Preserving the soft tissue plays an important part in the success of treatment. Transmit- ting this data to the dental tech- nician presents a challenge.6 In order to replicate the soft-tissue architecture, a standard impres- sion coping on implant #11 was individualised. Then, an impres- sion was taken of the implants at sites #11 and 21 using an individ- ualised and standard impression coping, respectively (Figs. 6a & b). The resulting plaster model was modified by grinding at site #21. Then, a silicone impression ma- terial was used to record the emer- gence profile of pontic #21 of the temporary bridge (Figs. 7a–c). This information was trans- ferred to a standard impression coping, which resulted in an in- dividualised impression at im- plant site #21 (Figs. 8a & b). At the next step, the situation was as- sessed using digital smile design analysis (Figs. 9a & b). The evalu- ation revealed a disproportion- ate distribution of volume be- tween the central and lateral in- cisors. The lateral incisors were too narrow compared with the wide and square shape of the central incisors. In order to en- hance the harmony, the volume should be distributed across the four incisors. New screw-re- tained temporaries were fabri- cated. Prior to this, a wax model was adapted and tested in- tra-orally to visualise the out- come. A silicone key was created to first build up the lateral inci- sors with a temporary composite material.7 With the temporary crowns and the composite mock-up of the lateral incisors, the shape of the wax-up could be trans- ferred. This blueprint served to evaluate the new smile in- tra-orally prior to fabricating the permanent restorations. Shade selection was performed with the help of cross-polarised light. Undesirable reflections were effectively eliminated with a polar eye filter. In order to fab- ricate the final prosthetic resto- rations, the temporaries were duplicated and 1:1 copies were made using IPS e.max Press (monolithic lithium disilicate; Ivoclar Vivadent). Screw-re- tained IPS e.max Press crowns were placed on the implants and the screw openings were filled with PTFE and covered with composite. Once the resto- rations had been placed, the lat- eral incisors were built up with IPS Empress Direct composite (Ivoclar Vivadent). A palatal ma- 10p 10q 10r 10s 11a 11b Figs. 10 a – s: Individual stages in the intra-oral fafrication of the composite fuild-ups on the lateral incisors.—Figs. 11a & b: Result: the shape, shade and size of the anterior teeth created a harmonious appearance.