Final Result 1 year later. Patient Case 19. Preoperative: Main Complaint:

Transcription

1 Patient Case 19 Preoperative: Main Complaint: The patient presented to the practice with the 21 that according to her started to move forward. Dental History I have been treating this patient for many years now. Notwithstanding, it has been more than two years since her last appointment. Her crowns were replaced circa She has a bridge anchor on the 23 with a pontic on the 22 and a post and core crown on the 21. The crown is mobile and following the removal of the crown for re- cementation, it was discovered that the root was fractured. An option was to extract the root and place an implant and to restore with a crown. The anterior proportions are very difficult and aesthetically an ideal result would be virtually impossible to achieve unless the anterior component is addressed as a whole. The patient does not want to replace all the crowns and would therefore accept a compromise as a result. Medical history The patient was diagnosed with Breast Cancer some twenty years ago. She was successfully treated and has been in remission since. Pre- Operative Diagnostic Photographs

2 PANOREX PERIODONTAL CHARTING No diagnosis of periodontal problems was made other than the drainage area regarding tooth 21. TREATMENT PLAN The treatment plan base on the walk out as you walk in principle 1. Extraction of the fractured root and immediate placement of an implant.

3 2. Use of the old crown as a provisional crown 3. 4 months healing period with placement of final crown 4. Contingency plan for post operative follow up and maintenance Intra operative The process flow of the treatment was to extract the root and complete the first stage up to provisionalisation in one visit Site 21 Extraction Post Extraction Open Site 21 Implant Stent in place Implant in place An atraumatic extraction was done with the buccal bone intact. Once the extraction was done, a flap was raised to confirm the position and status of the buccal plate. The implant was inserted and good primary stability was achieved. The cover screw was removed and the second part was to place the abutment and the provisional crown, which in this case was the old crown. Try- in abutment Final Abutment O- ring on abutment

4 The Tri- in abutment assists with the abutment selection for the specific implant system used in this case. The abutment has a particular shoulder height which must be taken into account when the prosthetic crown is made. The shoulder would determine the distance of the crown margin below the soft tissue. The placement of O- rings, which in this case are two orthodontic separation elastics, are to block out the acrylic form the undercut of the abutment. The acrylic is used to customise the fitting of the crown onto the abutment. Prosthetic Key In- Fill with particulate granules Sutured site Provisional crown The jump gap between the implant and the bone wall, in this case the complete circumference of the implant, is filled in with Bovine bone replacement mineral. The void on the apical area of the 22 is also filled in, only to act as a scaffold to support the soft tissue. The value of such an in- fill is not definite. It may well resorb. In this case it is not of significance, because of the low smiling line. It is also important to note that the provisional crown is freed of the occlusion, in all excursions as well as in centric. The patient was discharged with post operative instructions and her old crown as a provisional restoration. He was also supplied with a prescription for post operative anti- biotic, anti- inflammatory, analgesic tablets and an anti- septic mouth rinse.

5 The sutures were removed 10 days later with satisfactory healing of the soft tissue. The patient was in good health and all bruising and swelling had dissipated. The healing one week post operative also shows good tissue adaptation. The sutures marks are still visible in this instance. The ovate shape of the provisional crown onto the shoulder of the abutment supplies a very good support structure for the soft tissue. The final restoration will now be placed in 3-4 months POST OPERATIVE 4 MONTHS The patient did not want to replace all the anterior crowns in order to achieve a better aesthetic result. An impression was taken and the new crown was made to a best fit situation. The Soft tissue is healthy The Final crown There are some Bovine mineral granules visible, but the soft tissue is generally healthy. The granules were removed and the final crown fitted. The indifferent size of the centrals does not give a perfect result. It is however what the patient insisted upon. As clinicians, we sometimes must take heart from the fact that the result in terms of the technical aspects of implantology may be sufficient to claim a successful restoration. In this case, the picture was taken on the day of placement of the final restoration. The papillae have not yet settled in, but should reform in a very short time. The central papilla may well be shortened due to no contact between the centrals, but this is not the case on the central /lateral contact area. The patient may over time also realise that the asymmetry is not really ideal, whereby hopefully, she ll agree to have the rest of the anterior component restored.

6 The Final Panorex