DTME0710

mediate implants placed. Imp- ressions were taken so the pa- tient could be offered a remov- able temporary device once ex- traction and implants performed for the healing time. Treatment procedure Retained roots were extracted in local anesthesia (four per cent Articain) using minimal invasive procedure. The alveolae were thorough- ly scooped and cleaned. Avai- lable bone was sounded and found adequate for immediate implant placement. Two Bioho- rizons Ø4.0mm x 12mm external implants were inserted in the al- veolae. The remaining buccal gap to the buccal bone wall was less than 1.5 mm so that no further attention (fill) was requested. Implant in position 11 was performed ad modum flapless surgery. Once drill protocol as rec- ommended by the manufacturer has been performed a Biohorizons Ø4.0mm x 12mm external implant could be seated. Successful three-dimensional implant placement was performed following the criterias mentioned in the introduction. Bony and soft tissue healing went extremely well also due to available thick gingiva phenotype. After treatment Allocated healing time was five months. Second stage surgery was performed under local an- esthesia. Temporary abutments were screwed in place and tem- porary crowns performed. The emergence profile could be nice- ly shaped during the next visits. Impression was taken once optimal conditions were achi- eved. The technician manufac- tured three zirconia abutments. The final impression was taken and the final restoration were delivered after a try-in session with bisque bake. The final crowns were ce- mented while a retraction cord in place to enhance cement ex- cess removal. Occlusion was checked and patient received hygiene instructions. Recall ses- sions were scheduled. Conclusion It is of course only of anecdotal value to use a case presentation to exemplify the achievement of predictable aesthetics with con- ventional implant systems, but doubts might raised today about statements and claims made by modern implantology. The author recommends the following criteria as mandatory: • Good treatment planning • Adequate protocols • An excellent team (surgeon • restorative and laboratory technician) for predictable long- term success DT Clinical picture showing the alveolae im- mediate after the atraumatic extraction About the author Dr Liviu Steier (PhD) is Spezialist fuer Pro- thetik (www.dgzmk. de) and specialist in Eendodontics (GDC- UK). He is an honor- ary clinical associate professor at Warwick Medical School and course director of the MSc in Endodontics (www.war- wick.ac.uk/go/dentistry). He is a mem- ber of the Scientific Advisory Board for the Journal of Endodontics (AAE) and maintains a private referral practice for endodontics, implantology, etc at 20 Wimpole Street, W1G 8GF London (www.msdentistry.co.uk). DT! Picture showing the master model with gingival mask and ceramic abutments Direct clinical picture showing the ideal contour with adequate scalloped margins having thick collar and superbly mimick- ing natural conditions X-ray control show- ing the optimal fit of the abutments as well as perfect crestal bone levels Clinical picture at six months recall showing optimal soft tissue conditions, nice interdental papillae and natural emergence profile AD Page 3 News & Opinions DENTALTRIBUNE Middle East & Africa Edition4