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ePaper created 2017-12-06, 11:14:19 | version 1.38.0
| case report Natural preservation of the emergence profile Authors: Dr Umut Baysal & Dr Arzu Tuna, Germany Supplying single-tooth gaps with implants in the aesthetic zone is subject to strict evaluation. Objec- tively verifiable criteria like the “pink and white aes- thetic score” were elaborated1, 2 and scientific works focused mostly on the reconstruction of hard- and soft-tissue. However, these concepts are based on the principle of tissue reconstruction after tissue loss. The following case history pursues the ap- proach of preventing resorption processes after tooth extraction. Introduction An implant that does not differ from the neigh- bouring, natural teeth, meets the demands of dentist and patient. Imitating nature is the top priority. The creation of natural, true-to-life surface structures al- lowing for the distribution of light reflection and ab- sorption is key to perfect aesthetics. Modern ceramic materials facilitate the true-to-life reconstruction of dental hard tissue. If the tissue is not defective and allows for correct positioning of the implant, we can expect an aesthetically satisfying result. If hard- and soft-tissues show deficits though, ad- equate augmentation is required. Despite various therapeutic options, the reconstruction of three-di- mensional defects still requires great effort and can- not always be achieved completely.3, 4 Many concepts in implantology deal with the principle of tissue re- construction after tissue loss, even though methods of primary prevention of resorption processes are the actual key to success. Consequently, various methods like “socket preservation” and “ridge preservation” were developed in order to limit the horizontal and vertical changes after tooth extraction. In their over- view survey, Darby et al. did not provide any conclu- sive references that these published techniques im- proved the potential implant locations.5 Another technique, the immediate implant, per se is not a ridge-preserving measure, which was proved in animal and clinical studies.6, 7 The procedure applied in the following is based on the “tissue master concept” by Stefan Neumeyer. Neumeyer was able to show that replanting root seg- ments or highly resected teeth after extraction pre- vents the alveolar collapse and the subsequent extru- sion leads to coronal movement of the alveolar tissue structures.8 After a period of stabilisation between three and six months, the cavities of the residual al- veolar bone were filled entirely with osseous tissue. According to his case analyses, the cause seems to be the periodontal ligament (minimum width: 2 mm), which is able to convert mechanical stimulations into tissue reactions. Complete preservation and vertical gain of alveolar hard- and soft-tissue are predictable and clinically stable in the long term.9 Additional extrusion may induce the vertical gain of soft- and hard-tissue structures.9, 10 Fig. 1: Initial condition of tooth 23 on single-tooth radiograph. Fig. 2: Intraoral initial condition of tooth 23. Fig. 1 Fig. 2 12 implants 3 2017