CATEGORY AUSTRALASIAN DENTIST 81 CLINICAL Treatment planning Based on the tomography results, the suggested treatment plan for the patient involved the following steps: 1. Digital planning and design of a surgical template with coDiagnostiX® for static computer-aided implant surgery (S-CAIS) to enhance the 3D position of the implant based on a prosthetically driven approach (Fig. 6). 2. Extraction of the hopeless tooth #21 due to the horizontal fracture. 3. Immediate implant placement. 4. Gap filling with cerabone® and the use of a connective tissue graft (CTG) in the buccal zone. 5. Immediate loading using a pre-selected Variobase® and the patient’s same crown. 6. Final prosthetic rehabilitation with a screw-retained monolithic zirconia CAD/CAM implant-supported crown. This treatment protocol was selected based on the favourable anatomical conditions observed during the clinical examination and CBCT analysis, which likely included a preserved buccal bone wall, intact interproximal bone peaks and adequate bone density and volume to engage the implant in a favourable prosthetically driven position. The aim was to provide the patient with both function and aesthetics soon after the procedure and to maintain the emergence profile during the healing phase. Surgical procedure The patient was premedicated with amoxicillin 2 grams administered 1 hour prior to the surgical procedure. Local anesthesia was administered using 2% lidocaine with epinephrine 1:100,000. The atraumatic extraction of tooth #21 was performed using a flapless approach to reduce the risk of a buccal bone wall fracture and avoid soft tissue damage. Following the extraction, the site was thoroughly debrided, the surgical guide was placed, and the drilling protocol was performed according to the manufacturer’s instructions. A Straumann® BLX Implant, Ø 3.5 mm RB, SLA® 14 mm, Roxolid® was then placed in the extraction socket with the aid of the handpiece at a speed of 15 rpm. 55 Ncm of insertion torque was achieved. Gap filling was performed with botiss cerabone®, and a connective tissue graft was harvested from the palate and placed with a tunneling technique in the extraction site. Implant stability was assessed using the implant stability quotient (ISQ), achieving a score of 77, allowing for immediate loading. An RB/WB Variobase® abutment for the crown, with GH 3.5 mm, made of TAN (Titan alloy), was utilised. The extracted crown was used to pick up the abutment with resin, and the provisional restoration was polished to prevent irritation and accumulation of biofilm. It was adjusted to ensure no occlusal contact with the opposing arch during both centric and eccentric movements. The provisional restoration was screw-retained, hand-tightened and sealed with Teflon and composite resin (Fig. 7). Healing was uneventful at the suture removal appointment after 10 days. The patient was scheduled for periodic followup appointments. Appropriate contour management of provisional restorations directly influences the shaping of the emergence profile. Key factors include making necessary adjustments, regularly reshaping, timing modifications appropriately, and respecting biological principles. The results observed at 4 and 6 months demonstrate how these practices contribute to achieving the desired aesthetic and functional outcomes for the final restoration (Fig. 8,9). Prosthetic procedure After six months, with adequate tissue healing and the emergence profile properly created, the final impression was taken Figure 7 Figure 9 Figure 11 Figure 13 Figure 8 Figure 10 Figure 12
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