Dental Tribune United Kingdom Edition

February 14-20, 201116 Implant Tribune United Kingdom Edition T he patient, a 36-year-old fe- male office worker, was in- itially referred for implant therapy (via one of my implant course delegates) for replacement of the missing upper right central incisor. The upper central incisor had been lost following acciden- tal trauma when she was 17 years old; the resultant space had been initially restored with a removable denture, but more recently with an adhesive bridge. The patient was strongly opposed to keeping her denture having tolerated it for almost 20 years; and afraid that the ad- hesive bridge would fall out, she now wanted a fixed solution. Un- derstandably she did not want a conventional bridge as she was afraid of “cutting down” the adjacent healthy teeth. The rest of her dentition was largely un-restored. At the time of the trauma, the patient had asked her dentist if she was able to have a dental implant, but was told that there was insuf- ficient bone and that such treat- ment was impossible. On examination the pa- tient was fit and well, a regu- lar attender, non-smoker with low alcohol consumption. Extra oral examination found nothing abnormal. Intra orally, the patient had signs of widespread gingival re- cession, oral hygiene was excel- lent, with no deposits and BPE codes healthy in all sextants. The patient presented with a composite occlusal restoration (UL6, LL6) and an adhesive “Maryland” bridge restoring UR1 with retainer wings UR2 UL1. There was Class 1 occlu- sion with general overcrowd- ing, no interferences and ca- nine guidance. Radiographic assessment of UR2, UL2, revealed absence of periapical pathology, non-con- vergence of roots in adjacent teeth with good bone height. The missing upper right cen- tral incisor had healthy adja- cent teeth and a healthy, bony site. The edentulous area had reduced volume with respect to soft and hard tissue. Following a formal discus- sion of her treatment options and advantages / disadvan- tages of each, a treatment plan was formalised in a detailed written patient report and ver- bal and written consent to treat- ment was obtained. Treatment Plan 1. Two stage implant surgery was planned: Under LA, full flap elevation, implant place- ment (16mm NP NobelReplace tapered groovy) with hard and possibly soft tissue augmenta- tion either simultaneously or at second stage surgery. 2. Second stage surgery; uncov- ering of implant +/- soft tissue augmentation and attachment of under contoured modified healing abutment. 3. Fixture head impression for lab construction of ideal design screw retained composite pro- totype crown. 4. Fit prototype implant crown with negatively contoured sub- gingival emergence profile 5. Pick up impression using modified impression coping 6. Fit definitive under contoured zirconium abutment and all ce- ramic procera crown 7. Maintenance of implant res- toration and remaining denti- tion by GDP. Including contin- ued hygienist support. The treatment was car- ried out over a period of seven Single tooth anterior implant, the ultimate aesthetic challenge Dr Richard Brookshaw discusses an interesting case presentation, placing a single tooth anterior implant in a young female patient ‘At the time of the trauma, the patient had asked her dentist if she was able to have a dental implant, but was told that there wwas insufficient bone and that such treatment was impossible’ Fig 1: Preop periapical radiograph Fig 2: Preop photograph Fig 3: Remote flap design distal to UR2 and tunneling to UL1 distal retraction Pritchard’s Fig 4: Narrow platfrom replace select 16mm implant with buccal dehiscence and concavity Fig 5: Bone scraper utilised on nasal spine for autogenous bone augmentation Fig 6: Autogenous bone collection in titanium dish Fig 7: Placement of autogenous bone col- lection over implant surface with biooss sandwich layer to buccal deficiency. biogide resorbable membrane stabilised using palatal mucosa prior to covering bone graft www.theimplantcourse.com free implant ipod rrp £2000 for each delegate www.thenobelbiocareyearcourse.com tel: 0845 604 6448 201 - 201 TR199598 199598_BDJ_Biocare 22/4/10 11:22 Page 1 1 2MayLondon