Dr. Giuliano Garlini (Italy)

Overview

This case presents the extraction of tooth 11, which was fractured after a dive in a swimming pool, and its substitution with an immediate implant and a screw-retained provisional crown. The procedure is described step by step, from the extraction to the final restoration.

• Before & After

Clinical Procedure

• Clinical view of the upper right central incisor, which is misaligned, with a root fracture indicated by the arrow.

• X-ray examination of the two central incisors.

• Frontal and occlusal views of the provisional crown, showing the ideal position of the vestibular parabola of the future final crown.

• During surgery, it is of fundamental importance to ensure the correct implant insertion, which must be slightly palatal to the post-extraction socket in order to obtain the best esthetic result.

• After implant insertion, the gap between the implant and the residual vestibular bone must be filled with xenograft in order to prevent resorption of the thin buccal bone wall.

• The provisional abutment is inserted before relining the provisional crown on it.

• The provisional crown is positioned in the correct 3D orientation thanks to the presence of two resin stops. In this case, no connective tissue graft was inserted because the emergence profile of the right upper incisor was slightly coronal to the contralateral upper incisor.

• The provisional crown, just after removal from the patient’s mouth.

• Additional resin was added to create the ideal emergence profile.

• The provisional crown screwed onto an implant analogue, just after shaping the concave emergence profile.

• The provisional crown screwed into the post-extraction implant.

• X-ray to check the correct placement of the provisional crown.

• 6 months later, after soft tissue healing.

• The ideal emergence profile, before insertion of the implant transfer for impression-taking.

• Individualization of the implant transfer using the Hinds technique, in order to provide the laboratory with accurate information regarding the implant position and the soft tissue emergence profile.

• X-ray to verify the correct position of the implant transfer.

• Photograph for shade selection of the final crown.

• Zirconia-ceramic, screw-retained final crown.

• Final restoration of the right upper central incisor.

• Post-op periapical radiograph.

• 6-year follow-up.