Single implant crown adjacent to metal-ceramic crowns

The patient was referred by her periodontist who was not satisfied with her gingival health, even though periodontal therapy had been initiated. Furthermore, she was advised that her left lateral incisor required extraction. Clinically this 47-year-old patient presented herself with a strange gingival response around the existing maxillary incisor crowns with abnormal marginal gingiva that appeared very fragile. Additionally, root resorption on the maxillary left lateral incisor required tooth extraction.

The prosthodontic treatment started with the extraction of the maxillary left lateral incisor and implant placement followed by the removal of the three maxillary incisor crowns and repreparation of the teeth. After the impression was made, provisional crowns were provided. As a definitive treatment option metal-ceramic crowns with ceramic margins on the natural teeth along with placement of a custom abutment and cementation of a metal-ceramic crown on the implant were chosen. These steps were all accompanied by the conventional periodontal treatment that consisted of oral hygiene instructions followed by scaling and root planing.