Australasian Dentist Issue 93

PEOPLE 46 AUSTRALASIAN DENTIST CLINICAL Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 17 Figure 15 Figure 18 Figure 16 Immediate loading of a Neoss ProActive ® Tapered implant to correct upper right lateral incisor agenesis. Dr. Roberto Romano, Italy Patient: 22 year-old woman. Clinical situation: Agenesis of the upper right lateral incisor with a tissue deficiency on the buccal aspect. Treatment plan: Placement and immediate loading of a Neoss ProActive® Tapered implant restored with a screw retained zirconia crown. The patient needed an implant to replace the upper right lateral incisor missing due to agenesis (Figure 1 and 2). The CBCT scan showed a residual bone width of 5.6 mm in the palatal-buccal and 5.2 mm in the mesio-distal direction (Fig 3 and 4). Although the amount of bone was sufficient for implant placement, the soft tissue on the buccal aspect showed a concave profile (Figure 5). In order to reduce the treatment time, and thus the esthetic discomfort for the patient, the decision was taken to apply an immediate loading protocol. A full-thickness flap was raised on the buccal aspect in order to expose the surgical site (Figure 6). A Neoss ProActive® Tapered Implant 3.5 × 13 mmwas placed with a final insertion torque of 50 Ncm and 65 ISQ (Figure 7). A screw-retained provisional crown previously manufactured by the lab was adapted to a Neoss Esthetic Tissue Former – Narrow Incisor (Figure 8 and 9). The crestal incision was slightly palatally displaced in order to correct the lack of soft tissue on the buccal aspect when the flap was sutured (Figure 10 and 11). The concave aspect of the soft tissue on the buccal aspect appears corrected after 3 months of healing (Figure 12 and 13). Final impression was taken with a customized impression coping aimed to replicate the trans-mucosal path shaped by the provisional crown (Figure 14). The final restoration was a zirconia abutment with ceramic layered on the buccal aspect (Figure 15 and 16). After 3.6 years from the definitive restoration delivery, soft and hard tissue levels were stable and the esthetic aspect was satisfactory (Figure 17 and 18). u