Implant in the esthetic zone

147 Rating(s).


Posted on By Roland Ader In Failures

Hi,
the patient was referred for implant placement after traumatic tooth extraction D11. And the story begun...
*GBR - ABBM + autograft 50/50, titanium membrane
*7months later - implant placement, secondary bone graft, collagen membrane
*4months later - CTG, individualised healing abutment, temporary crown
*7months later - papilla regeneration according to Suzuki Masana
And now we are here.

How to proceed?

Your thoughts, critics and help are welcome!

This one after GBR. No baseline unfortunately
CBCT

Rx
Before the attempt of papilla regeneration


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6 Comments

I think the bridge would be a better option here from the esthetic point of view.
I would add pink porcelain and make cervical part of all crowns even with each other.


Reply

Thank you for your opinion, Gregory! Bridge will be an option we are going to discuss about


Reply

Interdental bone levels seem conducive to some papilla regeneration given time. I would change abutment ( and therefore crown) for a narrower sug-gingival emergence profile as too get more space for tissue. New better shaped composites on mesial of 7 and 9. And be patient, papilla levels, although imperfect, will improve after 6 to 12 months.


Reply

Thank you for answering, Laurent! We have lost bone around the implant and between the central and the lateral.


Reply

Roland; I would remove the implant crown and place cover screw....allow 4 weeks for tissue over growth and re-uncover the implant and replace the provisional with a concave labial emergence profile. Once this is done, I would consider slow orthodontic extrusion of the lateral incisor with LIGHT forces to address the papilla. Once done, (it should take 3 months) you could provide a veneer for the lateral. Good luck and keep us posted. Dr. Salama


Reply

Thank you for answering Maurice! Going to discuss further plans with the patient. The lateral had a bit of movement during last appointment. Don't you think that the movement would increase after orthodontic extrusion?


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KLS Martin
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