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ePaper created 2017-12-06, 11:14:19 | version 1.38.0
| industry Overcoming a difficult aesthetic situation Author: Prof. Dr Dr M. Kemal Unsal, Turkey Introduction Case report Fig. 1: The tooth had received a root treatment and a ceramic laminate restoration ten years ago. Fig. 2: Upon intraoral and radio- graphic examination, the tooth was diagnosed with a horizontal crack and decided to be extracted. Fig. 3: As the buccal bone wall was intact, no membrane was used. Fig. 4: Marking the gum level with a permanent pen just before extraction. Fig. 5: Roughening of the glazed surface of the ceramic restorations with diamond burs. Fig. 6: Application of only orthophos- phoric acid of 36 per cent on the natural enamel of tooth #22 for 30 seconds and composite bonding. Immediate implantation is becoming frequently applied in implant dentistry. Although this technique can be used in many situations, the cases which benefit most are the trauma cases. Associated with an aesthetic issue, the teeth suffering the most from trauma are the incisors. Immediate implant treat- ment can be the preference of the clinician who would like to cope with time restrictions and aesthetic issues. However, primary stability issues do not always meet immediate loading protocols. In that case, it is the responsibility of the surgeon not only to have an acceptable level of primary stability, but to predict the insertion depth of the implant in order to achieve an aesthetic outcome. In the pre- sented case, the resorption prediction was not accu- rate enough. This special challenge was successfully mastered with the help of the implant manufacturer. The custom abutment prepared for this case was added to the NucleOSS catalogue as an option for all users of the system. A 58-year-old woman without any systemic disor- ders attended our clinic. Her main complaint was the increased mobility of her upper left central incisor #21. The mentioned tooth had received a root treat- ment and a ceramic laminate restoration ten years ago (Fig. 1). Upon intraoral and radiographic exam- ination, the tooth was diagnosed with a horizontal crack and decided to be extracted (Fig. 2). The remain- ing broken root piece was also extracted as a single piece. An immediate NucleOSS T6 implant with a length of 12 mm and a width of 4.1 mm was inserted. The buccal aspect of the extraction socket was filled with a xenograft. As the buccal bone wall was intact, no membrane was used (Fig. 3). It is quite possible to observe bone resorption around immediately placed implants. In order to avoid possible aesthetic problems due to this bone loss, cli- nicians generally tend to position the implant a bit deeper and palatally. The loss of a central upper incisor Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 22 implants 3 2017