CDE0111

I 23 special _ implants I cosmeticdentistry 1_2011 Fig. 17_Pre-op X-ray. Fig. 18_Resin-bonded provisional restoration after extraction of teeth #23 and 24. Fig. 19_Eleven weeks post-extraction. Fig. 20_Papilla preservation with ovate pontics. Fig. 21_Eight weeks post-implant placement. The advantages of one-piece implants include minimally invasive surgery, simple restorative procedures and no screw loosening. Furthermore, the amount of crestal bone resorption may be minimised, since there is no micro-gap or micro- movementbetweentheimplantanditsabutment. This becomes even more critical for long-term aesthetic results in the anterior region. In order to demonstrate the successful use of one-piece implants, this article describes the restoration of mandibular incisors with one-piece MDIs. _Case reports Case I A 67-year-old female patient presented with occasional throbbing pain in the mandibular anterior region. The patient’s medical history was non-contributory. Clinical and radiographic eval- uation revealed two separate peri-apical lesions on teeth #23, 25 and 26 (Figs. 1 & 2). The patient reported that tooth #24 had been extracted 15 years ago. The incisors were deemed non- restorable and treatment planned for extraction. Owing to the size and duration of the peri-apical lesions, delayed placement of implants was planned. The teeth were carefully luxated with a periotome and atraumatically extracted, pre- serving the thin facial bone. A wire-embedded provisionalrestorationwasfabricatedandbonded to the adjacent canines with flowable resin (Figs. 3 & 4). After ten weeks of healing, the provisional restoration was removed. The distance measured between the two mandibular canines was 15 mm (Fig. 5). A crestal incision was made and a limited soft- tissue flap was reflected to expose the alveolar crest of bone. In this fashion, the patient ex- periences reduced post-operative swelling and discomfort. With a 1.6 mm twist drill and copious irrigation,osteotomieswereperformedataspeed of 1,500 rpm. The angulation of the twist drill was carefullymonitoredthroughouttheosteotomies. Following completion of the prepared implant sites, visual and tactile inspection of the internal bony walls was performed to ensure the absence of any fenestration or dehiscence at the cervical area. Two 2.5 mm-diameter implants (MS implant, Osstem) were then placed in the ideal 3-D posi- tion and torqued to 25 Ncm with a manual torque wrench. The superior margin of the transmucosal portion was positioned 2 mm apical to the soft- tissue margin (Figs. 6 & 7). Immediately following implant placement, provisional restorations were fabricated at chairside using prefabricated tem- porary abutments and acrylic resin. Theprovisionalrestorationsweresnappedinto position using the friction-fit temporary abut- ments, eliminating the use of cement (Figs. 8 & 9). This could remove the risk of cement being forced into the gap between the implant fixture and soft tissue. The provisional restorations had no centric or eccentric occlusal contacts. The patient was instructed to avoid any function of the im- plant for eight weeks. Fig. 20 Fig. 21 Fig. 18 Fig. 19Fig. 17