Which Tooth Is the Implant? What is The Pink/White Esthetic Score of that Implant Restoration?

235 Rating(s).


Posted on By George Duello In Implants

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.

Duello Case-Final Prosthetics
Patient Result

Pre-treatment cross section #9
Socket Grafting of #9 site with xenograft and allograft


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14 Comments

#9
I don't know anything about the P/W score :)

R


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#9


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For those unfamiliar with the Pink/White Esthetic Scores-please see this link for an explaination.

http://iaoi.pro/asset/files/iboi_pink_&_White_esthetic_score.pdf

Please copy and paste in your browser. Hope this helps.


Reply

George; I was never one for this concept because it seemed important to qualify and quantify scientific data but not really a clinical assessment. Having said that, one short coming of the PINK SCORE has been the lack of a TISSUE COLOR score in this concept??
My guess here is that #9 is the implant crown. The WHITE SCORE is excellent IMHO but I would not be happy with the Tissue Color?? This would lead me to believe that a post-op CBCT would show some labial bone resorption and possible dehiscence of the implant body.
I will await your answer. What is the score here and which are the implants? regards Mo


Reply

Mo,

7 & 10 with cantilever 8&9 or 8&9 with cantilever 7&10

cheers,

Richard


Reply

Richard;
You can ONLY have ONE single answer.
Mo


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#9


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Mo,

9 & 10


Reply

8 and 9


Reply

8 & 9 it is....what score do you give them??


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George, can you tell implant here? (^______________^)


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second bicuspid


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Armando

I can never tell with you cases...

#4

R


Reply

George;
A nice result and very much acceptable to patient who endured no extended time without a tooth. BUT, I would LOVE to see an post op CBCT here. I would BET that we are missing labial bone to an extent.....an regardless of the images there still appears color change of the labial tissue that is coincident in my experience with bone resoprtion or lack of adequate KT thickness. Please, please talk this patient into a Focused Field CBCT....it would be an awesome teaching moment for ALL. Thanks Mo


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