CDE0111

24 I I special _ implants Fig. 22_Modified impression caps. Fig. 23_Indexing jig. Fig. 24_Final prosthesis. Fig. 25_Eleven-month follow-up. Fig. 26_Peri-apical X-ray. cosmeticdentistry 1_2011 After a healing phase of two months, a final impression was produced using friction-fit im- pression caps (Figs. 10 & 11). Definitive restora- tions were then fabricated on the working cast and adjusted to have slight occlusal contacts in centric occlusion and excursive movements (Figs. 12–14). The clinical re-evaluation demon- strated a minimal gingival change around the prosthesis, and a stable horizontal bone level was observed radiographically at the 13-month follow-up (Figs. 15 & 16). Case II A 58-year-old male patient presented with severe mobility and peri-apical lesions on teeth #23and24(Fig.17).Aprovisionalrestorationwas fabricated and bonded to the adjacent natural teeth immediately following extraction (Fig. 18). The provisional restoration was left undisturbed for 11 weeks and the interdental papillae were preserved with ovate pontics (Figs. 19 & 20). Theinterdentaldistancemeasuredbetweenteeth #22 and 25 was 8 mm, and two 2.5 mm-diameter implants were placed in position. The superior margin of the transmucosal portion was posi- tioned sub-gingivally, and the height of the abutments was reduced to ensure adequate incisal clearance (Fig. 21). Owing to the limited interdentalspace,theimpressioncapsweremod- ified (Fig. 22). An indexing jig was used to avoid any undue stress applied to implant fixtures during the impression procedure (Fig. 23). An altered cast was made, and a definitive prosthesis was fabricated. The clinical and radiographic evaluation at 11 months demonstrated a good aesthetic result with no significant peri-implant bone loss (Fig. 24). Dr Chonghwa Kim specialises in prosthodontics and implantology.He works in a private practice in downtown Seoul,Korea.He graduated from the University of Michigan School of Dentistry in 1997 and completed prosthodontic training at the University of Minnesota.Dr Kim is Co-director of the Global Academy of Osseointegration and serves as a Director of international relations for the Korean Academy of Esthetic Dentistry.He can be contacted at kimchonghwa@hotmail.com. Fig. 24 Fig. 25 Fig. 26 Fig. 22 Fig. 23 _Conclusion Based on the clinical cases presented in this article, the utilisation of one-piece MDIs appears to be a good treatment option for replacing miss- ing mandibular incisors. Considering the sim- plicity, ease of implant placement and immediate provisionalisation, this treatment offers a new option for patient care._ _about the author cosmeticdentistry