0 Evaluation & Diagnosis
1 Progress & Completion
2 Follow-Up & Outcome

Patient cases:

Single-unit restorations

(Maxilla / Anterior)

Implant- and tooth-supported central incisor crowns

Lead:

Charles Goodacre

A 22-year-old football player suffered from a traumatic injury which led to an avulsion of his maxillary left central incisor and severely damaged his other central incisor. The treatment selected was the placement of a single crown on tooth #11 FDI (#8 US) and a single implant to replace tooth #21 FDI (#9 US). Due to the extensive bone loss, the implant was placed with concomitant bone grafting.

Evaluation & Diagnosis

Initial situation.

Periapical radiograph of initial situation: #8 (FDI #11) root canal treatment due to trauma, #9 (FDI #21) missing, insufficient bone volume.

Progress & Completion

Flap reflection revealed extent of bone loss.

Bone graft material placed.

Membrane placed over bone graft.

Sutures placed.

Reopening and uncovering of graft

Osteotomy for implant placement.

Implant placed.

Cover screw placed.

Sutures placed around transmucosal healing abutment.

Preparation of natural tooth and implant in situ.

Preparation of #8 (FDI #11) for metal ceramic crown and healing abutment removed for implant level impression.

Incisal view before placement of custom abutment and crowns.

Facial view before crowns were placed.

Facial view of custom-made abutment.

Metal ceramic crown cemented showing more apical position of mucosa on implant crown compared to adjacent crown on natural tooth.

Periodical radiograph after implant placement.

Periodical radiograph: #8 (FDI #11) restored with composite resin.

Periapical radiograph made at time crowns were cemented.

Display of extensive bone loss encountered during surgery.

Shade 1M2 below #10 (FDI #22).

Shade selection: 1M2.

Master cast with gingival mask.

Palatal view of master cast.

Implant crown with custom-made abutment.

Definitive restorations.

Apical view of definitive crowns.

Tissue blanching from seating crown.

Clinical situation post cementation.

Follow-Up & Outcome

Clinical situation at 1-year follow-up.

Periapical radiograph made 6 months following cementation.

Questions

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Team members

Prosthodontist

Thomas Kepic

Surgeon-Periodontist

Satoshi Sakamoto

Dental Technician

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