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Restoring aesthetics and function

13 September 2013

Restoring aesthetics and function

Dr Marius Steigmann presents the case of a patient requiring implant treatment following extraction of a central incisor

This patient attended the practice complaining of pain associated with tooth 11 and slight mobility. Following a trauma 10 years earlier, endodontic treatment had been carried out on the same tooth. Initial clinical examination suggested the tooth had started to elongate spontaneously (Figure 1).

   

Figure 1                                       Figure 2

The X-ray (Figure 2) showed the root canal treatment and a previous apicectomy. The view of the interproximal bone did not suggest that there had been any resorption.

Following removal of the crowns on the central incisors (Figure 3), which had been in place for many years, it was confirmed that tooth 11 was mobile and needed to be extracted.

Figure 3

After the extraction, which was carried out in an atraumatic manner with the help of a periotome, leaving the buccal plate intact, an immediate implant (BioHorizons’ Laser-Lok) was placed flaplessly to avoid injury of the soft tissue (Figure 4).

Figure 4

The Laser-Lok system comes with an abutment that can be used to help indicate ideal placement of the implant.  For this case, the margins were prepared to align with the cemento-enamel junction of the adjacent teeth, to create a harmonious emergence profile. The Laser-Lok engaged the bone interproximally and the soft tissue buccally. The Laser-Lok collar design allows for a transitional placement of slightly supracrestal to crestal positioning. Supracrestal placement of a portion of the collar allows for soft tissue functional attachment to the microchannels, thereby protecting the crestal bone in a manner similar to the connective tissue attachment of a natural tooth1.

After the cover screw had been positioned, grafting material (MinerOss) was placed, along with a native collagen wound dressing cone (Collacone, Botiss) to avoid losing any of this mixture of allograft mineralised cortical and cancellous chips (Figure 5). This was sealed by the temporary pontic, which was attached to the adjacent prepared tooth (Figure 6). 

   

Figure 5                                         Figure 6

Six months later, when the implant was uncovered, the X-ray showed that the abutment was attached to the implant (Figure 7). A hollow was created in the temporary pontic and two weeks later an impression was taken.

      

Figure 7                                     Figure 8                                          Figure 9

After two weeks we removed the crown on tooth 22, along with the attached pontic on the site of the implant (Figure 8). The soft tissue was found to be healthy both buccally and interproximally. Figure 9 shows the buccal aspect of the soft tissue following removal of the abutment.

Figure 10

The next step was to try-in the porcelain fused to metal (PFM) crowns, using hand pressure to shape the 3-dimensionality of the soft tissue (Figure 10). Figures 11, 12 and 13 show the final PFM crowns on the two central incisors.

     

Figure 11                                      Figure 12                                    Figure 13

Reference

  1. BioHorizons Laser-Lok Microchannels. Inside Dentistry 7(8)

Dr Marius Steigmann, DMD, UMF Neumarkt, PhD, is an Adjunct Assistant Professor of oral and maxillofacial surgery at Boston University. In Romania, he is an Honorary Professor of the Carol Davila University and Visiting Professor in the department of implantology at the University of Timișoara, while in Hungary he is a Visiting Professor at the University of Szeged.

Dr Steigmann lectures and publishes extensively, and is a member of several dental associations. He is the founder and director of the Steigmann Institute (www.steigmann-institute.com), and maintains a private practice in Neckargemünd, Germany, which is limited to aesthetic dentistry and implantology.

 

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