GAP Australasian-Dentist-May June 2019

Category 32 AustrAlAsiAn Dentist (Fig. 16). A flap was then raised after a vertical incision of the frenulum and the expected buccal exposure of the implant neck was evident. Autogenous bone harvested from the drills was positioned directly on the implant surface (Fig. 17), followed by a bone substitute on top of it and on the buccal cortical bone (Fig. 18). this material was covered with a resorbable membrane (Fig. 19). the mobilised flap was then repositioned by rotating it coronally and fixed with single sutures (Fig. 20). the removable partial denture was adapted and delivered (Fig. 21). An immediate postoperative CBCt scan of 60 x 60mm was performed, and it confirmed a perfectly centred implant position (Figs. 22 & 23). Intraoral scan eight days after surgery, the patient reported that healing was uneventful and the prosthodontist removed the stitches. it has become the author’s standard protocol to perform an intraoral scan for implant position in this same session (Figs. 24 & 25). the specific and unique PeeK healing abutment used has an internal circular channel and on one side, normally positioned on the buccal aspect, a vertical rectangular slot (Fig. 26). After removing the PtFe tape used to plug this area during surgery, a scanPeg can be positioned inside the healing abutment. this allows for a unique scanning procedure without removing the healing abutment, thus avoiding disturbing healing tissue or dislocating recently placed biomaterials. the producer provides libraries for stl files of the five different anatomical shapes—wide incisor, narrow incisor, canine, premolar and molar—that determine the basic profile of the gingival tunnel during healing. Temporary crown the surgeon indicated that the healing abutment may be removed after four weeks. By then, the temporary screw- retained crown had already been fabricated by the technician, who had prepared a CAD/CAM-milled acrylic tooth glued on to a neoss neolink abutment (Figs. 27–30). As a result of the decision to place the implant entirely in native bone, the angulation was such as to locate the screw access hole of the provisional on the buccal aspect. this can be easily camouflaged by a simple composite filling after plugging the channel with PtFe tape. the gingival profile copies in this first stage of loading the central incisor anatomy of the neoss Aesthetic Healing Abutment (Fig. 31). Tissue conditioning As evidenced by the aesthetic analysis before treatment, it was clear that symmetry with the contralateral incisor would be impossible. the implant was placed slightly distal because the distal papilla normally has a narrower mesiodistal basis than the central papilla. the tissue volume augmentation helped to obtain the necessary quantity of gingiva to shape nice papillae, leaving a minimal gap. the soft tissue architecture lInICal Fig 27 Fig 34 Fig 29 Fig 36 Fig 31 Fig 28 Fig 35 Fig 30 Fig 37 Fig 32 Fig 33