Dental Tribune UK Edition, September 20-26, 2010, Vol. 4 No. 22

M r W was referred to the Kent Implant Studio wishing to replace his upper left central incisor. The patient was wearing a partial denture which he was unhappy with, and did not like the idea of a conventional bridge. The pa- tient was medically fit, healthy and a non-smoker. After discussions with the patient and the referring dentist, it was decided the tooth would be replaced with an implant supported crown. There was a buccal defect ap- parent. The history of the tooth was a trauma incident (cricket bat) which led to the tooth frac- turing and needing endodontic treatment around 30 years ago. The tooth subsequently needed an apicectomy. The apicected site was apparent with a soft tis- sue area apical of the previous tooth. There was also a buccal defect present 12mm from the edge of the ridge. Ridge Mapping clearly indicated a bony defect of at least 12mm in height. Soft tissue analysis showed 8mm of defect at the edge of the ridge narrowing to the shape of the previous tooth. There seemed to be a height defect buccally compared to palatally of around 2mm. These measurements were confirmed during the re- flection of the flap during sur- gery. If an increase in width was needed, ridge widening could be considered, however, the de- fect on ridge mapping measures 1mm at crestal level; a difficult procedure considering this case. There also seemed to be a buccal height defect, which cannot be corrected with ridge widening. Therefore, augmentation was the proposed option. This could be either guided tissue regeneration with the use of bovine/irradiated bone or graft- ing procedures using intra-oral donor sites. The defect was of height and width, and a J shaped bone graft would be of more use: therefore the ideal site for a donor would be the Ramus. As the patient was missing both his wisdom teeth, either side could be considered. As the ID canal was more clearly visible on the OPG and identifiable through- out on the right hand side, the right Ramus was the more ideal site. A ramus graft was obtained from the right ramus as planned and positioned in the upper left central incisor area. Three months were allowed for bone healing, and subsequently an implant length of 14mm and width 4.5mm (Ankylos B14). Primary stage impressions were obtained (an impression at the stage of implant placement). six months were allowed for implant integration, and sub- sequently the implant was ex- posed using a small ‘H’ shaped incision, with the incision point more palatally, thus allowing a bulking effect of the gingivae buccally. The already chosen abut- ment with the correct angle (22.5 degrees) was fitted and an already constructed temporary acrylic crown was fitted. The crown was adjusted at the gingi- val margins so to define the final contouring of the gingivae. The final restoration was fitted after three weeks of gingival healing. The patient was delighted with the end result, and was surprised the treatment was not painful and that he was able to fully function the next day after all the stages. The patient was returned to the referring dentist for routine care. DT Aesthetic Zone needing Augmentation Dr Shushil Dattani presents an interesting case ‘The patient was delighted with the end result, and was surprised the treatment was not painful and that he was able to fully function the next day after all the stages’ About the author Dr Shushil Dattani BDS, MFGDP(UK), DipImpDent RCS (Eng) Principal of the Kent Implant Studio and Kent Smile Studio in Maidtstone, Shushil qualified from the Royal Lon- don in 2000, after which he completed a two-year programme and member- ship to the Faculty of General Dental Practice at the Royal College of Sur- geons. He is accredited with a Diploma in Implant Dentistry at the Royal Col- lege of Surgeons of England and is a member of the Association of Dental Implantologists, the American Acade- my of Cosmetic Dentists and regularly trains and attends courses around the world including the pioneering Ameri- can and British Cosmetic Dentists. For more information or to refer to the Kent Implant Studio please call 01622 754 662 The buccal defect is apparent in the clinical photos. An implant without bone grafting would produce an incorrect emergence profile leading to an aesthetic compromise. Clinical pictures: note the correct emer- gence profile duplicated the adjacent inci- sor and the increased buccal width. 27Case StudySeptember 13-19, 2010United Kingdom Edition