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6 CASE STUDY AN IMPLANT PROSTHETIC TREATMENT CONCEPT – THINKING BIOLOGICALLY AND PLANNING FOR SUCCESS Dr. Kai Zwanzig, Bielefeld (Germany) Case description Figures 1 and 2 show the clinical situ- ation of the 52-year-old female patient described in the article. After completion of the preliminary examinations and a de- tailed explanatory discussion, and taking into consideration the patient’s wishes for a fixed, full-ceramic restoration, the following treatment plan was specified. Tooth 36, which had received root canal treatment, was extracted because the en- dodontic revision had a poor prognosis and would have been very protracted and expensive. Although the patient had been very critical of an implant procedure prior to the consultation, in agreement with the patient we opted for a single crown resto- ration on two implants in regio 35 and 36. We apply this strategy if the long-term prognosis of a tooth directly in the surgical area cannot be guaranteed and the costs of revision exceed those of the implant. A laboratory-prepared long-term tempo- rary abutment temporarily closed the gap from 33 to 37, which also showed the patient that a bridge restoration definitely would not be a solution for her in this area. The article describes restorative therapy that enables one to achieve predictable results that are stable over the long term. The surgical phase Based on the visual diagnosis, it was suspected prior to the surgery that there was a considerable bone defect (Fig. 3) . A three-dimensional X-ray did not appear sensible in such a case because there would not have been any therapeutic consequen- ces if the patient had been informed prior to surgery of the need for implant resto- ration with bone augmentation. In regio 35 and 36 a full-thickness flap was formed to expose the bone surface in the surgical site (Fig. 4) . The flap is extended mesially and distally as a split-thickness flap with no vertical releasing incisions to give the flap sufficient mobility and to avoid un- necessary deperiostation, which always leads to bone resorption. The external vi- sual findings were confirmed during surge- ry. With the help of a guide template, the implant bed was successively prepared in the prosthetically correct orientation using rotary instruments (Fig. 5) . Even before insertion of the implant the buccal cor- tical bone was perforated in places. We expect more rapid migration of vital cells from the induced bleeding sites (Fig. 6) into the augmentation material [8,16]. We do this before implant insertion because Fig. 1: The X-rays shows the initial situation for the patient prior to reconstruction of the maxilla and mandible. Fig. 2: The patient was bothered by the transverse bar in the maxilla, the poor chewing function, and the esthetics. Fig. 3: A bone defect was already suspected during the visual examination. Over the past few years we have learnt a great deal about the biology of the oral cavity. Our job now is to systematically apply this knowledge. Implantology has become a complex discipline in which it is extremely rare to manage without augmentative measures. The peri-implant soft tissues must be given a great deal of attention because they play a critical role in an esthetic reconstruction that is stable over the long term. Full- ceramic restoration components around the emergence profile provide considerable support for the biology and are now considered the gold standard.