CAMLOG Special Issue – Implant Replacement

Before Photo RETROSPECTIVE REVIEW Fig. 23: Many different treatment plans could have been applied to this situation. It was necessary not only to replace the fractured tooth but also to stabilize the supporting structures. In the process it was desirable to enhance the esthetics. After Photo Fig. 25: At the five year recall, it can be seen that the goals of therapy were met and that the final situation is not only stable and functional but also esthetic. Fig. 24: Starting radiograph. Fig. 26: Final radiograph 2010. It’s always useful to review a case on completion. Could a better result have been achieved by other means? Could the case have been handled more efficiently and with fewer surgical interventions? Howwill the result survive over the long-term? Would one use the same procedures, apply the same principles and materials these days? Well, the five year evaluation shows the result to be quite stable. If anything the adjacent natural teeth have deteriorated slightly, but the implants, their restorations and the environ- ment around them seems unchanged. When this case was done, immediate implant therapy was not common. Neither was minimally invasive therapy, osseous augmentation around im- plants, “tunnelling” under flaps, flap advancement and soft tissue augmen- tation at the time of implant placement. The rationale behind all these pro- cedures is to stabilize the environment in an extraction socket and to prevent the inevitable hard and soft tissue loss which follows tooth loss. By thinking logically and by respecting the local biology it is possible to obtain predictable and stable long-term results. The only changes to therapy that would be applied these days would be to use Promote ® Plus implants instead of Promote ® , to use Geistlich Bio-Oss ® Collagen instead of Geistlich Bio-Oss ® granules, to take a location impression at the time of implant placement and to place a custom zirconia Emergence on a K2244 Titanium Base Component at the time of second stage implant exposure. These would speed and improve healing and reduce the number of procedures.