Page 13 - GP Spring 2022

Figure 21. At 4 months, crestal tissue de-
epithelialized and healing abutment.
After six months of healing, the patient fore the fabrication of the final restoration and the screw was torqued to 35 Ncm ac-

cording to the manufacturer’s recommen-
was scheduled for implant surgery. The (Figure 21). Figure 24. Crown insertion.
same pre-surgical protocol was followed. dations (Figures 24-26).
A full-thickness flap with a single papilla
sparing incision was made and the cyto-
Figure 17. After 6 months a full-thickness flap
plasm membrane was removed (Figures
with a single papilla sparing incision was made
17,18).
and the cytoplasm membrane was removed.

Figure 25. Crown insertion.
Figure 21. At 4 months, crestal tissue Figure 24. Crown insertion.
de-epithelialized and healing abutment.
A 4.8(D)xC2x4.5(H) BestSolid abutment
(EBI Implant System, Seoul, Korea) was
Figure 18. Membrane removed. placed and hand tightened, a new lab-fab-
Figure 17. After 6 months a full-thickness
flap with a single papilla sparing incision ricated provisional crown was relined over
was made and the cytoplasm membrane the abutment and temporarily cemented.
was removed. The goal of provisionalization is to directly
load the implant with a new lab-fabricat-
ed temporary to mimic the anatomical and Figure 25. Crown insertion.
Figure 26.
Radiograph of
aesthetic characteristics of the tooth that Over the course of the
is being replaced. After every successful on. next five years, the
crown inserti
implant placement in the aesthetic zone, patient kept up with
it is vital to provisionalize in order to de- implant maintenance,
Figure 22. Soft tissue appearance. including intra-oral
velop the desired soft tissue architecture
and emergence profile (Figure 22). When x-rays and pictures,
to ensure the health of
the implant (Figures
27, 28).
Figure 18. Membrane removed.
Figure 26.
Discussion
Osteotomies were prepared for the single Figure 27. Five years post-insertion.
Radiograph of
implant, and an EBI BLT tapered effect im-
Figure 19. Osteotomies. crown insertion. Every aspect of den-
tal implant treatment
plant (EBI Implant System, Seoul, Korea)
was placed (Figure 19) in a 3D format so
Figure 22. Soft tissue appearance.
the healing abutment is removed, the tis-
sue has a circular shape and does not match
the natural tooth’s shape at the crest; this
Figure 28. Radiograph of the implant 5 years
problem is magnified with the central in-
after placement.
cisors. For the best result, this part of the Figure 27. Five years post-insertion.
Figure 19. Osteotomies. treatment should not be overlooked. After builds on top of each
multiple surgeries, the area of the implant other as the clinician
the prosthetic access hole could be on the and soft tissue needs to be retrained to ac- drives the therapy for-
lingual side. Primary closure was attained cept the fixed crown, which will allow the ward. The following
and post-operative instructions were re-
Figure 20. Radiograph of implant placement. clinician to recreate the proper zenith of the factors influence the
outcome of any aes-
viewed with the patient (Figure 20).
soft tissue. This process requires up to 4-6
Figure 23. Single crown screw-retained thetically driven case,
weeks before the site may be ready for the
restoration.
After 4 months of final restoration. from successful GBR
healing, during stage and GTR to position-
two, the crestal tis- Figure 28. ing the implant in a 3D
sue was de-epitheli- Radiograph of the fashion as a foundation
alized, a semilunar implant 5 years for the final restoration.
incision was made after placement. Another important con-
sparing the papillae, sideration is the loca-
and the tissue was tion of the contact point for the presence
rotated under the or absence of the interproximal papilla.
buccal side to in- Figure 23. Single crown screw-retained Ultimately, it has been established that
crease the thickness restoration. implant dentistry is a restorative-driven
Figure 20. Radiograph of the soft tissue. discipline with a surgical component at-
of implant placement. Proper healing time A single screw-retained crown was fabri- tached to it. The aesthetic outcome can be
was allowed be- cated (Figure 23). The crown was inserted compromised even with a successful bone
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