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13Implant TribuneMay 17-23, 2010United Kingdom Edition page 15DTà meal approach over some years, and the most of the teeth in ques- tion were root treated and re- stored with post crowns. The overall aesthetic situa- tion was compromised by the ap- pearance of short clinical crowns, giving the teeth (particularly the central incisors) a rather ‘short and broad’ appearance (Fig 1). In addition, there were pre-existing endodontic treatments and post crowns in a number of the teeth and residual apical radiolucen- cies evident on some of the teeth (Fig 2). These were asymptomatic (except for the failing left central incisor); the right lateral incisor and canine had been apicected and retrograde root filled a cou- ple of years prior, the right central incisor had been previously root treated and contained a fibre post and composite core although the root filling was difficult to assess radiographically. However, as the tooth was stable and symptom free it was decided to accept the situation as re-treatment would be difficult, and lastly the radiolu- cency on the left lateral incisor had been symptomless and stable for a number of years and may have been a scar. Nevertheless, it was clear that the prognosis of some of these teeth was uncertain and that further surgical endodontic treatment may be required in the future for the left lateral and pos- sibly the right central incisor. The patient was made aware of this and the risk of possible future root fractures, particularly in the left lateral incisor where there was a large metallic post. An additional point to note is that the presence of metallic post and cores and dark-root substrate makes ideal colour of the gingival margins tissue difficult to achieve and has to be managed carefully when being restored with all-ce- ramic restorations to avoid affect- ing the value of the crowns. The maxillary left central in- cisor needed surgical endodontic treatment, but had to be removed shortly after due to root fracture (Fig 3), and it was not possible to place an implant immediately due to the infection and damage to the labial bone. Soft-tissue healing A provisional metal-acrylic fixed- partial denture was fabricated and fitted at the time of tooth ex- traction and soft-tissue healing allowed to occur (Fig 4, 5). After approximately six weeks surgi- cal treatment was performed to place the implant and augment the bone and soft tissues in the implant site. A wide mucoperio- steal flap was raised across the anterior maxilla using sulcular incisions with no vertical releas- ing incisions necessary. At the same time, crown lengthening of the maxillary anterior teeth was carried out, by recontouring both the gingival margins and labial alveolar bone around the anterior teeth. Figure 6 shows the damage to the labial bone plate in the area of the tooth extraction and loss of labial contours in that area. Positioning the implant The correct three-dimensional Fig 1. Case 1 at presentation. Note the short and broad looking crowns. Provisional crowns had already been fabricated for the cen- tral incisors. Fig 2. Pre-treatment radiograph with presence of apical radiolucencies. Most of these are healed scars, but maxillary left cen- tral incisor is failing. Fig 3. View of extracted tooth with root fractures and extrusion of root filling. Fig 4. Provisional bridge in place and tissue healing at six weeks post extraction. Fig 5. Radiograph at six weeks post extraction prior to implant surgery. Fig 6. View of surgical site after raising the flap. Note the extent of the defect and the missing labial bone. Fig 1. Fig 4. Fig 2. Fig 5. Fig 3. Fig 6. For more information, contact BioHorizons Customer Care: +44 (0)1344 752560 Email: infouk@biohorizons.com visit us online at www.biohorizons.com BioHorizons is known for using science and innovation to create unique implants with proven surgical and aesthetic results. Laser-Lok microchannels exemplify our dedication to evidence-based research and development. The effectiveness of Laser-Lok has been proven with over 15 years of in vitro, animal, and human studies at leading universities.† This patented precision laser surface treatment is unique within the industry as the only surface treatment shown to inhibit epithelial downgrowth, attract a true, physical connective tissue attachment to a predetermined zone on the implant and preserve the coronal level of bone; long term.‡ Laser-Lok is currently available on Tapered Internal, Single-stage, and Internal Implants. Laser-Lok® dental implant at 8 years post-restoration showing superior crestal bone & tissue maintenance. aesthetics enhanced by technology † Clinical References available. ‡ Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant. M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim. The International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008. SPMP10032 REV A FEB 2010 Laser-Lok® microchannels Case courtesy of Cary A. Shapoff, DDS (Surgical); Jeffrey A. Babushkin, DDS (Restorative)

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