2 eaed dhr jansen
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Transcript of 2 eaed dhr jansen
Patient 2
Patient 2
* male
* 35 years
* patient’s request: - solution for discoloured
central incisor (21) - (referred patient)
* no medical condition
periodontal chart
buccal recession 11 and 21
21 internal root resorption, discoloured
diagnosis
slight crowding 21,11
buccally positioned 11,21
how could we satisfy the patient’s aesthetic wishes?
is it possible to improve soft tissue levels 11 and 21 (more incisally)
Is the patient willing to go through orthodontic treatment, periodontal surgery and to manage teeth restoratively?
can we restore this patient predictably with long-term strategy?
primary concerns
Can the hard an soft tissue volume be maintained/ improved/stabilised after extraction 21
how do we manage the space problem
extraction 21
if possible immediate implant placement and ridge preservation
adjust soft tissue levels 11 and 21with connective soft tissue graft
restore 21 with provisional restoration (resin bonded bridge) for 2 months
treatment plan
restore 21 with ceramic restoration
restore 21 with provisional restoration (screw retained) for 6 months
soft tissue maturation and management phase (6months)
restriction of treatment: only 21 (soft tissue 11)
atraumatic extraction
atraumatic extraction
T r e a t m e n t
O u t c o m e
resin-bonded bridge screw retained provisional
1st. provisional 2nd. provisional final impression
tunnel technique, (split thickness)
full thickness flap, dubbel-sling sub-papilla sutures
Grafting outside the box...
buccal hard tissue support
ridge preservation
connective tissue graft
resin-bonded provisional bridge, ovate pontic design
three weeks healing
eight weeks healingthree weeks healing
eight weeks healing initial soft tissue contour
osseo-intergration prosthetic soft tissue management
1st. provisional 2nd. provisional final impression
screw retained provisional restoration
provisional restoration insertion
adding contour for the restorative environment
2nd. provisional final impression
Final restorative contour (6 months)
communication to laboratory
customized CAD/CAM abutment
zirconia abutment linered with ceramics
etching ceramic and silane application
two half deflection cords
Before...... ..... After (2 years)
4.5 Year Result
cementation 4.5 years