CAMLOG Special Issue – Implant Replacement

Case Report 01 | 2010 CONCLUSION The challenge of a case like this is to plan an even, smooth progression bet- ween stages. It’s a matter of developing a vision of what one is trying to achieve, then working steadily and progressively to realize that vision. Along the way there are certain critical stages. In this case, there were three surgical options at the outset, but when the vertically fractured tooth was removed it was possible to move to immediate implant placement with con- current augmentation of both hard and soft tissue complexes. However, as is often the case, the initial implant stability was inadequate to support a provisional restoration, so it was useful to have a provisional bridge ready to put into place. This allowed healing to progress quite natu- rally, with no loading on the implants, bone graft or the soft tissue complexes. When it came to the restorative phase, emergence profile development was critical. When the transgingival connection was made, the soft tissues over- lying the healing cap were displaced rather than excised. An impression was taken at the same time, and the provisional restorations followed within a week. These started developing the desired emergence contours. The con- tours of the two teeth differed slightly. The implant replacing the left cen- tral incisor had been skewed slightly to the labial, so the contours of the provisional restoration were corrected to the lingual. Both provisionals were contoured against the lateral incisors and each other to develop the desired papillae form. Instead of being blunted, and rounded, they became sharpened, elongated and «normal». Moving forward to the final abutment and final restoration was then quite predictable, but still fraught with potential for error. These days, it’s a rela- tively simple matter to copy-mill the contours of the final provisional, or at least those present in the sub-gingival region; and to reproduce those in the final abutment. However, five years ago when this case was done, it was necessary to alter stock components to achieve the desired results. In this case a 6.0 mm stock ceramic component was down-sized at the neck to fit a 5.0 mm post. This allowed a wider emergence, one that maintained the papillary contours achieved in the provisional. The final crowns on both the natural teeth and on the implant abutments were then able to blend and appear natural. In every complex case, it’s valuable to identify the stages of therapy that will be required. At the end of each stage, it’s useful to stop and to re-eva- luate the progress made. Slight alterations of therapy may be required and should enhance the final result. Changes provided towards the end of therapy should be refinements. Much depends on the biological response to therapy provided. Before After Therapy took nine months. On completion, the esthetics were improved and the situation was healthy and functional. All the way through treatment the patient had a fixed dentition. He was delighted with the result. Here againwas the situation at the start of therapy. A crisis situation with the fractured tooth was super-imposed on an unesthetic, deteriorating environment. The need for therapy for the im- mediate local problem needed to be blended with therapy to stabilize and improve the function and esthetics of the whole region. Fig. 19: Original situation 2004. Fig. 21: Final situation 2005. Fig. 20: Starting radiograph. Fig. 22: Final radiograph 2005.