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ePaper created 2017-12-06, 11:14:19 | version 1.38.0
case report | Fig. 13 Fig. 14 Fig. 15 The dental impressions were taken in an analogue procedure using a closed tray via a transfer cap (Fig. 18). The next step was the manufacture of an in- dividual hybrid abutment (titanium adhesive bond- ing, zircon abutment) at the laboratory. A digital dental impression would have the advantage that data scanned before the tooth extraction could be matched with the impression after exposure, thus enabling an exact copy of the natural tooth in line with the “biogeneric copy” concept.10 In the present case, we abstained from the digital workflow because the crown was individually manufactured in lami- nated ceramics. The dental crown was replanted again after the impression was taken. In the next session, the definite abutment (Fig. 19) and a synthetic crown were tried on for aesthetic analysis. We removed the composite residues from the adjacent teeth and fixed the abutment tightly us- ing a new screw according to the manufacturer’s in- structions (Fig. 20). A new silicone impression was made in filament technique. This impression serves to manufacture of the crown with the newly defined contact points to the adjacent teeth. Previously, the laboratory had manufactured an analogue to the abutment of super-hard plaster to ensure the exact preparation of the crown margin. Figure 21 shows the abutment after removal of the composite residues from the adjacent teeth. The synthetic crown was fixed using provisional cement (Telio CS Link, Ivoclar Vivadent). We were thus able to abstain from another replantation of the dental crown. The synthetic crown provides us with diagnostic value with regard to the final appearance of the peri-implant soft tissue and the form of the crown.12 Additional optimisation by applying and removing provisional masses to form the emergence is not necessary anymore in most cases. This shortens the treatment duration consider- ably. Figure 22 shows the definite crown right after its placement (Variolink Esthetic DC, Ivoclar Vivadent). Discussion Prerequisite for aesthetic prosthesis with long- lasting stable soft tissue is the correct positioning within the three regional comfort zones. If no tissue defects are available, predictable results involving single- tooth implant crowns of the anterior teeth can be achieved.12 The adjacent teeth contribute to sup- porting the peri-implant tissue and determine the height of the papilla. Schropp et al. reported though that the extraction of teeth promotes the resorption of the adjacent tis- sue.13 After three months, cervical resorption reaches an extent of 30 per cent and labial resorption an ex- tent of up to 50 per cent. The initial resorption pro- cesses after tooth extraction are physiological pro- cesses that cannot be prevented from today’s point of view. Reference literature describes the implementa- tion of various augmentation strategies to optimise the volume in case of available defects in detail. Hor- izontal ridge augmentation to widen the alveolar ridge effectively are available and provide for stable results in the long term. The described techniques to augment the alveolar ridge, however, are consider- Fig. 13: Template-guided pilot hole (MIS Guide). Fig. 14: After the pilot hole, the implant bed was further prepared, exclusively with osteotomes. Fig. 15: 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 was used (V3, MIS Implants). Fig. 16: Condition after implantation and prior to replantation of dental crown. The atraumatic status and the complete preservation of the emergence profile are remarkable. Fig. 17a: Condition right after implantation. Fig. 17b: Single-tooth radiograph after implantation. Fig. 16 Fig. 17a Fig. 17b implants 3 2017 15