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ePaper created 2017-12-06, 11:14:19 | version 1.38.0
| case report Fig. 6 Fig. 7 Fig. 8 Fig. 6: After ten days already, a loss of marginal gingiva of about 1 mm in apical direction is evident. Fig. 7: Condition prior to extrusion by means of rubber bands over a period of 24 hours. Fig. 8: Condition after 24 hours. The reactive tissue in the marginal area is very nicely shown. The soft tissue is the first to follow the traction, then the bone. Fig. 9: Three-dimensional imaging shows that volume loss is prevented and complete ossification of the extraction alveole could be induced. Fig. 10: Single-tooth radiograph of region 23 after complete ossification. Fig. 11: Condition after removal of replanted crown and prior to implantation. Fig. 12: Access to the bone was established by means of a micro scalpel blade. Fig. 9 palatinal direction with sufficient osseous volume of 2 mm on the buccal side. The replanted crown makes it possible to plan the implant position allowing for the prosthetic component in terms of backward plan- ning. A template-guided implantation facilitates the incision-free technique and shorter treatment period, reduced patient morbidity, and better surface texture of the soft tissue. Figure 11 shows the situation after removal of the replanted crown and prior to the im- plantation. Using a micro scalpel blade, access to the bone was established (Fig. 12). Afterwards, the pilot hole was drilled using the template (MIS Guide, Fig. 13) and the further preparation performed with osteotomes (Fig. 14) after inspection of the buccal bone lamella. Despite the preventive measures, the purely subtractive preparation of the implant bed us- ing drills was not indicated. We used a 3.3/11.5 mm implant in a special triangular design of the crest, which increases the bone deposit in the critical zone additionally (V3, MIS; Figs. 15 and 16). After the implantation, the crown was replanted. Figures 16a und 17a show the status of the soft tissue right after the implantation. The atraumatic status and the complete preservation of the emergence pro- file are remarkable. A single-tooth radiograph was prepared to check the implantation (Fig. 17b). Exposure and dental impressions The implant was re-exposed three months after the initial implantation. In the meantime, the bonding of the replanted crown had failed once. Because of the slightly undercutting points of the composite, the re- planted crown is not lost, but only becomes loose and is retained well by fibres and ligaments. The patient wears a splint at night for protection against aspiration or swallowing. The atraumatic exposure and removal of the replanted crown and the subsequent exposure of the implant using a micro scalpel blade cannot be compared to the typical exposure technique. Fig. 10 Fig. 11 Fig. 12 14 implants 3 2017