CATEGORY 82 AUSTRALASIAN DENTIST CLINICAL Patient Medical History: A young patient attended the ILAPEO office in June 2021 with dental mobility of the four upper incisors, clinical aspect with good condition of the soft tissues and absence of gingivitis. Radiographic images indicating external root resorption probably as a consequence of orthodontic movements. Planning: Initially, panoramic radiography and intraoral scanning were performed. The STL file of the intraoral scan was aligned with the DICOM and four Helix GM® 3.5 x 13mm implants were planned to be placed immediately after the extractions. All implants and abutments were designed using coDiagnostiX. All data were exported to 3Shape Dental System to create custom zirconia abutments prior to surgery. The guide, all custom zirconia abutments, and PMMA copings were produced prior to surgery. A template was printed for some minor adjustments prior to surgery. Description of the procedure: Teeth were extracted flapless, with minimal trauma. Both the osteotomy and the implant placement were guided, following the treatment planning previously carried out for the surgery, which was aided by software. Final implant placement was directed by the guide marks. This procedure is important, as the customized zirconia bases must be adapted to the temporary crowns created according to the patient’s anatomy, occlusion and esthetics. Prosthetic adjustments to the temporary crowns were made after implant placement. Grafts were made with Straumann Cerabone to close the gap between the remaining alveolar bone and the implant and no suturing was required. The positioning of the implant, the zirconia base and the PMMA crown guided the healing of the fresh socket in order to establish a natural emergence profile seen five days after surgery. Prosthetic description: After six months of the biomaterial healing, the patient was asked to return and make the definitive ceramic prosthesis. On this occasion, the provisional was removed, the cement was cleaned, and 2 retractor cords were inserted in each of the grooves, one #000 and one #00, with the aim of exposing the margin of the customized zirconia abutment. An intraoral scan was performed, and the temporary crowns were fitted. At the end, four ceramic crowns were cemented. Neodent® Materials: Dr Sérgio Rocha Bernardes Dr Geninho Thomé Guided rehabilitation with implants in upper incisors region, after loss due to root resorption By Dr Geninho Thomé, Brazil and Dr Sérgio Rocha Bernardes, Brazil Collaborating team: Dr Carolina Accorsi Cartelli and Dr Jean Uhlendorf. Fig 1. Initial radiographic aspect of the case. Fig 4. Guide with marks for the implant final position. Fig 2. Initial clinical aspect of the case. Fig 5. Teeth extraction with a minimum trauma. Fig 3. Design of the final zirconia customized abutment. Fig 6. Final implant placement with 60N.cm of torque. Helix GM® 3.75 x 16mm GM Exact Titanium Base
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