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May 17-23, 201012 Implant Tribune United Kingdom Edition Dr Tidu Mankoo demonstrates the interdisciplinary restoration of six maxillary anterior teeth and a single Nobel Active implant T he goal of any implant therapy in the aesthetic zone is to produce a resto- ration of the tooth (or teeth) that blends inconspicuously into the patient’s smile and maintains sta- ble soft-tissue form over time. It is understood that bone and soft tissue remodelling occurs around all dental implant restorations and while this remodelling has been attributed to a number of factors, it is now commonly ac- cepted that it is probably due to the establishment of a “biologic seal”, commonly described as a “biologic width” between the free gingival margin to the crest of the peri-implant alveolar bone 1-3 . A number of factors have been proposed as playing a role in this process 2-16 and in recent years, new implant designs have been suggested as being poten- tially helpful to reduce the im- pact of the remodelling process on the marginal bone; therefore creating enhanced stability of the marginal soft peri-implant soft tissues. While it is clear that the components alone are not the whole story, nevertheless most of the new designs serve to en- hance the thickness of the soft tissue cuff around the neck of the implant restoration and create a narrower transmucosal contour often combined with an element of “platform-switching”. Of course, the clinical man- agement of implant restorations in the aesthetic zone has involved anticipation of the consequences of this remodelling and strategies that reduce or negate the impact of possible soft tissue and bone changes. It is increasingly evident that the volume of bone and the tissue quality, tissue thickness and tissue biotype around our im- plants in the aesthetic zone play a key part in maintaining long- term aesthetic outcomes 9,17-18 . These new concepts for com- ponent designs generally aim to create a transmucosal “under- contour” which logically, in turn, increases the available volume of peri-implant soft tissue and in effect thickens the soft tissue cuff around the implant-abutment complex 14-22 . The Clinical Case In this example, a 35-year-old female patient with a history of extensive dental treatment re- quired revision of her previously restored maxillary anterior teeth (canine to canine), as well as ad- ditional treatment in the posterior regions, which are not relevant to the article. The teeth had been previously crowned in a piece- The Nobel Active implant Abstract This case illustrates the use of the Nobel Active (Nobel Biocare) implant for restoration of a failed maxillary central incisor, as part of the wider interdisciplinary restoration of the maxillary anterior teeth, in a 35-year-old female patient with a history of extensive treatment including previous crowns, multiple endodontic treatments and post cores. There are a number of key factors in achieving inconspicuous aesthetic integration of an implant restoration, particularly in the case where a failed maxillary central incisor has led to considerable damage to the alveolar bone and compromised soft tissue volume. 3 Avoid the Inferior Alveolar Canal: 4 Years Post Op 4 Years Post Op 7 Years Post Op 5 Years Post Op 3 Avoid the Maxillary Sinus: 6 Years Post Op 4 Years Post Op 12 Years Post Op 7 Years Post Op THE BICON DESIGN is driven by simplicity. A cornerstone of its simplicity is short implants. When the Bicon system was first introduced in 1985, its 8.0mm length implants were considered quite short—most other implants were at least 12–14mm and sometimes 18–20mm long! Since then, the natural progression of Bicon’s design philosophy has resulted in 5.0mm, 5.7mm, and 6.0mm short implants, all with proven clinical success. 4.5 x 6.0mm 5.0 x 6.0mm 6.0 x 5.7mm Since 1985 » Simple. Predictable. Profitable. Contact Andrea Kiddell UK Manager ■ Bicon Marketing Limited 8 Hadleigh Business Park, Pond Hall Road, Hadleigh, Suffolk IP7 5PW TEL: 01473 829299 ■ EMAIL: noscrews@bicon.co.uk ■ www.bicon.co.uk Bicon SI-NI Outsert UK 1109 2a.indd 1 11/17/09 4:34 PM