DTUK2010

19Implant TribuneAugust 2-8, 2010United Kingdom Edition Initial findings and treat- ment plan T he 30-year old patient had lost tooth 21 in an accident about 15 years previously. Tooth 11 underwent root treatment (Fig. 1). As a re- sult of fear of the dentist, the pa- tient continuously delayed treat- ment of the two teeth and wore a temporary denture for years. The treatment plan envisaged an im- plant in position 21 and a crown on 11. Since the incisive papilla was directly in the implant re- gion, cone beam tomography was performed in order to clarify the position of the incisive canal. The width of the bony ridge at position 21 was five mm meas- ured in the sagittal plane (Fig 2). Treatment A mucoperiosteal flap was dis- sected for the implantation with vertical relief distally at tooth 22. As expected, the incisive ca- nal was only slightly palatal to the ideal implant position. The implant site was prepared with the aid of a splint along the buc- cal boundary of the canal (Fig 3) without perforating the canal. A Straumann® Bone Level Implant (4.1 mm, length 12 mm) could be placed in correct prosthetic po- sition without dehiscence (Figs 4, 5). Because of the thin buc- cal bone plate and the concavity of the ridge, augmentation was performed with a bone substi- tute and a collagen membrane, fixed with resorbable pins (Fig 6). At tooth 11, 1mm of crown lengthening was performed on the buccal aspect. The flap was mobilised and sutured over the wound without tension (Fig 7). The sutures were removed ten days later; the wound area healed uneventfully. After healing the soft tissue over the implant did not yet have the desired convex contour and had a rather uneven structure (Fig 8). Therefore, eight weeks after implantation, a split flap was dissected buccally in region 21 and a connective tissue graft from the palate was inserted (Figs 9-10); in addition, the mu- cosa was de-epithelialised with a diamond bur in order to smooth the surface. The connective tis- sue graft allowed volume to be gained buccally (Fig 11). Eight weeks after graft insertion a mini rolled flap was formed over the implant and folded in the buc- cal direction with a conical gin- giva former (Fig 12). At the same time, tooth 11 was prepared for a crown and fitted with a direct temporary. Two weeks later, the impression for the indirect temporaries was taken. In the laboratory, a screw-retained Individual Anterior EstheticsThe Possibilities of Straumann® Cadcam in combination with a conventional technique page 20DTà Fig 1 Fig 2 Fig 3 Fig 4