CATEGORY AUSTRALASIAN DENTIST95 CLINICAL Emergence pro le shaping can be messy work if using a owable composite to form an individual healing abutment, but placing a pre-milled, sterilized, individual zircon healing abutment only takes a couple of seconds. Although we planned it smaller than the original tooth diameter, we had an opportunity to advance the grafted soft tissue area with hanging sutures to the abutment (Fig 8). CASE 2 A 28-year-old female patient was referred for tooth extraction and immediate implant placement at site #19 (3.6. FDI). e CBCT scan showed a perforation of the distal root. Due to an adequate bone socket and density it seemed to be favourable to place an implant immediately (Fig 11, Fig 12). Similar to Case 1, our aim was to preserve the surrounding soft tissues after the extraction. However, the main di erence was that this lower rst molar tooth was multirooted. e implant site preparation was performed after dissection of the roots but before the atraumatic extraction, which allowed more stability for the guided drill and more accurate preparation (Fig 13, Fig 14, Fig 15). Although the implant was placed in the inter-root septum, there was no gap between the buccal wall and the implant body. e mesial and distal sockets were lled with a 50-50% xenograft-autograft mix (Fig 16, Fig 17). e intrasulcular connective tissue grafting and individual abutment placement were performed in the same way as for Case 1 (Fig 18, Fig 19, Fig 20, Fig 21, Fig 22, Fig 23). Fig 6. Deepithelized palatal CTG graft Fig 7. Intrasulcular CTG graft After 3 months of healing, the clinical appearance of the peri-implant soft tissue looked to be perfect and the papillae were well preserved. A digital impression was taken using a Medit I700 intraoral scanner. Due to its swiftness, digital scanning is a perfect method of communicating the emergence pro le shape with the lab. It’s essential to take an impression of the pre-shaped emergence pro le as soon as possible to prevent any deformation of the soft tissue (Fig 9). As the nal prosthetic work, a fullcontour, screw-retrained, zircon crown was made. To the great satisfaction of the patient, the nished crown t perfectly into its environment. To mimic the natural appearance of a tooth, in addition to a wellperformed white aesthetic, the marginal gingival texture, colour, shape and proximal papillae presence are also important factors (Fig 10-1, Fig 10-2). Fig 8. Pre-milled healing abutment & hanging sutures Fig 13. Guided implant site preparation after root dissection Fig 9. Well-shaped emergence profile, after 3 months of healing Fig 10-1, Fig 10-2. Monolithic zircon, screwretrained crown, and preserved soft tissue Fig 12. Pre-milled zircon healing abutment Fig 15. Minimal invasive extraction using Benex system Fig 11. Initial situation Fig 14. Prepared implant site Fig 18. Epithelized graft was harvested Fig 16. Preserved inter-root septum for implant placement Fig 19. Deepithelized CTG suturing Fig 17. Placed implant
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