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Burzin Khan, Mumbai, India Adaro Dental Laboratory Mumbai

Aesthtetic rehabilitation of a single tooth case

Introduction

Case description

It is of utmost importance in cases of immediate implant placement that the implant position is not too labial and is within the safety zone for labial plate preservation with a good emergence profile. Grafting the gap may or may not be necessary and is dependent on the jumping dis-tance. The soft tissue gingival profile needs to be preserved, adequately supported and duplicated effortlessly (made possible due to the aesthe-tic line which makes provisions for the temp abutment, impression post, and the final abutment in preformed profiles S, M,& L). Sometimes customisation of the abutment is required to improve the aesthetics.

Conclusion

A 35 year old female patient reported to us with a fractured tooth no. 22, due to trauma. 21 & 22 were previously root canal treated and crowned. 22 was fractured at the cervical region with poor restorative prognosis. She had a restricted smile due to discrepancies in tooth size and shape. Treatment plan: 22 was temporarily bonded and a putty index was prepared, allowing an immediate provisional treatment after extraction and immediate implant placement. It was decided that a Blue Sky Implant with a Sky Temp abutment should be placed, which would allow for an immediate restoration.

The fractured root piece was extracted atraumatically with a periotome. A blueSKY 4x14 mm implant was placed flapless in the safety zone away from the labial plate (between the incisal & cingulum lines of the adjacent teeth). A torque of 45 Ncm² was achieved (there was good primary stability with apical engaging in the palatal). The labial bone plate was palpated through the socket before implant placement and, as a fenestration was present, Novabone putty was used to graft the gap (the jumping distance was <2mm). A SKY temp M abutment was placed and the screw torqued at around 18-20 Ncm², which adequately supported the gingival profile and the interdental papillae. The collar scallop was adjusted. A provisional crown was fabricated from the preoperative index and kept completely out of centric & protrusive contacts. The adjacent teeth, i.e. 12 13 & 23 were prepared for ceramic (E max) veneers to improve the smile and profile of the teeth (patient did not agree to a veneer on 11 or to have the crown on 21 redone). A diagnostic wax-up was performed and a mock-up was transferred to the mouth to check the final outcome. After five months of healing and bone maturation, a final impression was made. The decision was made to fabricate a customised E max abutment which would be luted to a SKY elegance Titanium base to support the gingival profile. Finally, the E max crown and E max veneers were luted with Rely X veneer cement. The smile shows a satisfied and confident patient.