CONELOG Special Issue

Case Report 16 | 2013 A young female patient with full-ceramic crowns on teeth 12 to 22 wishes for new restorations. These restorations are to look bright and natural. The medical history is inconspicuous, the gingival type is classified as “thin”. Tooth 11, with root treatment, cannot be saved and needs to be replaced with an implant. To obtain the most realistic picture possible of the initial situation, the dental technician photographs the patient in his laboratory. Using this photo and the initial models, he defines the shape and color of the planned restorations and carefully analyzes their positions in the arch for the temporary restoration. On the basis of the data obtained, a temporary bridge is fabricated from teeth 12 to 21 for the day of extraction of tooth 11. INFORMATION ON PATIENT AND TREATMENT A large part of treatment and the technical work steps were performed ana- log. The impression was also taken using conventional techniques. A spe- cialty here is the use of a two-part hybrid abutment as base for the pressed ceramic veneer. To obtain a biochemically optimal titanium bonding base, a straight CONELOG ® Esthomic abutment was customized in place of the al- ternatively available CAD/CAM component. The secondary zirconium oxide abutment was waxed up, then both components were scanned. This is where the CAD/CAM process came into play with the fine-tuning of the de- sign on the screen and machine-fabrication of the zirconium oxide secondary abutment. Despite using a titanium primary abutment, the dental technician achieved a natural light effect by the consequent use of fluorescing materials. Fig. 1: The female patient wants a new restoration with bright, natural-looking crowns in the regions 12 to 22. Initial situation Fig. 3: Self-made photos and the situation models are evaluated for esthetic analysis, and all details dili- gently recorded on an appropriate form. Fig. 4: After removing the temporary crowns on 12 and 21, the supra-alveolar periodontal attachment of tooth 11 is severed with a periotome. Fig. 2: Tooth 11 is not worth saving and to be replaced with an implant. Fig. 6: The palatal margin of the alveole is marked with the pilot drill through a deep-drawn template prepared in the laboratory. Fig. 7: When inserting the implant (CONELOG ® ), the surgeon orients himself along the palatal bone wall. Fig. 8: The implant is palatally displaced in the correct position, the buccal bone lamella no longer exists. Fig. 5: The root is extracted following atraumatic removal of the crown. The buccal bone lamella connected to the root surface was lost during the process. Immediate implantation Despite a lack of bone wall, an immediate im- plantation as planned is to be performed. With the aid of the deep-drawn template prepared in the laboratory, the positions are marked prior to preparing the implant bed. After preparing the implant bed without a template, the CONELOG ® implants Ø 3.8 mm/13 mm are inserted. A connective tissue graft is harvested from the palate and inserted using the tunnel technique to improve soft-tissue conditions.