Which Tooth Is the Implant? What is The Pink/White Esthetic Score of that Implant Restoration?
This patient was referred for implant therapy in the anterior esthetic zone. His therapy has been completed by the referring prosthodontist. Please assess this final slide relative to the title-which tooth is the implant prosthesis and what is it's Pink and White Esthetic Score?
On July 28th, I will demonstrate the techniques used to achieve this case.
Thanks and good luck.
Answers--Tooth #9 is an implant-all other teeth are natural. PES is 9 and WES is 10 as evaluated by prosthodontist.
Case presented with Class IIB socket with loss of buccal plate on #9. Tooth was extracted an an allograft/xenograft mixture was placed. After 3 months, a CBCT was taken and the case was placed for a 2mm pilot hole drill with a NobelGuide. The implant was placed with a punch incision through the guide and the implant achieved primary stability at 35ncm. A screw retained composite temporary was placed on the 3.75x13mm conical connection implant was placed by the periodontist. Care was taken to have an concave emergence profile. No sutures were placed.
After 3 month of healing, osseointegration was complete and the patient was referred to the prosthodontist. The final crown is a Angled Screw Channel/ with cutback porcelain over the base zirconia. The implant screw was torqued to 35ncm through an access hole that was in the middle of the lingual fossa.
Due to the high smile line and present tooth form, it is my opinion that we do not attempt to disturb the mesial and distal papilla is very important. The punchless implant placement from the guide preserves the keratinized attached gingiva and the platform switch implant connection with a temporary that does not disturb the papillae or buccal keratinized gingiva is critical.
The prosthodontist uses a customized impression coping to match the emergence profile of the tissue of the temporary is also key. The lab technician in this case is very experienced with implants in the esthetic zone. He is very careful in his design to not push on the tissue of the emergence profile. With a screw retained ASC design we are able to have a final crown that is screw retained to avoid any peri-implantitis associated with cement retained crown/abutment solutions.
A fellow DentalXP expert, Barry Goldenberg, has discussed these type of cases in detail. One of his guiding principles is that two objects can not operate in the same place at the same time. We make sure to keep the gingival were it should be buy not altering it or incising it and we make sure to replace, the white areas, to match texture, shape, and shade of the adjacent teeth.
I would like to acknowledge, Dr. Tom Matthes, as the treating prosthodontist and Mr. Gerry Jacobi as the lab tech in this case.