Australasian Dentist Issue 89

Category 72 AustrAlAsiAn Dentist s uccessful restoration of a single tooth edentulous space in the anterior maxilla is not only dependent upon long term osseointegration, but achieving and maintaining optimal aesthetic outcome is profoundly desirable. it is well established that bone volume reduction occurs after tooth extraction and as a result bone augmentation, either simultaneously or as a two-staged procedure, may be necessary for implant-supported restorations. there continues to be a debate whether tissue level (tl) implants are indicated in aesthetic zone with increasing number of clinicians preferring the Bone level (Bl) implants in aesthetic zone. there is however, paucity of evidence to contradict that tl implants are unable to achieve and maintain optimal aesthetic outcomes when used in maxillary aesthetic zone. this case report presents a 10-year outcome of a maxillary anterior tooth with a circumferential bone defect around the implant which was successfully replaced with straumann ® slActive tissue level implant Initial situation A 20-year-old male patient presented with an infection associated with #11. A previous history of sports injury resulting in root canal treatment and post-crown ten years earlier was reported. Clinical examination revealed root fracture and chronic radicular abscess within middle 3rd of the root between #11 and #12. the coronal portion of #11 had extruded resulting in a favourable coronally positioned gingival zenith (Fig. 1). Probing pocket depth of 7mmwas noted on the palatal aspect. A midline diastema was present. the radiograph confirmed the root fracture with a radiolucent halo around the root and the prognosis was deemed to be hopeless. Treatment planning the patient expressed a preference for replacement of the tooth with a dental im- plant. type 2 implant placement protocol was chosen and simultaneous guided bone regeneration with bovine deprotienized bone and porcine collagen membrane was consented for. A provisional removable acrylic denture was planned as an interim prosthesis. Surgical procedure After extraction of the crown and the fractured apical root fragment (Fig. 2), exploration of the socket confirmed lack of labial (facial) bone with a crater type bone defect at the crestal aspect. A bovine hemostatic collagen plug was placed and the socket was allowed to heal. After six weeks healing (Fig. 3a-b) a curvilinear, papilla preserving incision was made. A circumferential bone defect with a broad base but limited to the coronal aspect was encountered. (Fig. 3c). the granulation tissue was thoroughly debrided to leave a clean bone surface. implant site was prepared in an ideal 3-dimensional position for a screw-retained restoration (Fig. 3d). A straumann tissue level design tapered effect slActive implant was placed with adequate primary stability. the bone defect was grafted with autogenous bone shavings harvested locally followed by deproteinised bovine bone and finally covered by porcine collagen membrane (Fig. 3e-3g). the implant was submerged after achieving a tension free primary closure of flaps (Fig. 3h). implant exposure was carried out 3 months later and a bevel healing abutment of 3.5mm height was placed. Straumann®Tissue Level hydrophilic implants in the aesthetic zone – a 10-year follow-up A clinical case report by Shakeel Shahdad, uK lInICal Figure 1 Figure 2 Figure 3a Figure 3b Figure 3c Figure 3e Figure 3d Figure 3f Figure 3g Figure 3h