logo 17 • CAMLOG Partner Magazine • March 2018 12 Dr. Hajo Peters, Vienna IMPLANT-BASED ANTERIOR TOOTH REHABILITATION WITH MAXIMUM INTERDISCIPLINARY CONCEPT Fig. 1: Clinically normal initial situation five years after endodontic restoration of tooth 11. Fig. 2: Radiological 3D representation of the upper jaw defect with erosion in the incisive foramen (axial layer) as well as loss of the labial compact bone in sagittal reconstruction. This case study describes the one-year surgical and prosthetic therapy, the special dental features as well as the current one-year follow-up of a 24-year-old patient who was treated with an anterior tooth implant (CAMLOG® SCREW-LINE). In order to meet the demands of the patient as a professional musician both functionally and esthetically, the Viennese esthetic protocol developed by MDT Christian Koczy, Dr. Otto Exenberger, and Dr. Hajo Peters was used, which is based on the close interdisciplinary approach between dental technician, prosthodontist, and surgeon. This protocol is a maximum concept which will be presented in all its details. The documentation describes the diagnosis and clinical procedure from anterior tooth removal in the maxilla with extensive cystectomy, via the temporary restoration, reconstruction of the alveolar process, implant positioning, and augmentation of the soft tissue through to shaping and restoration using individual ceramic prosthetics. Case history and clinical examination During a routine dental examination and subsequent diagnosis by means of panoramic tomography, an extensive radiological translucency around the anterior maxilla was detected in the patient, who was 22 years old at the time of the examination (2014). According to initial information provided, the patient was free of symptoms and had a normal oral situation for both soft tissue and hard tooth substance (Fig. 1). The patient is a professional musician (saxophonist) and specific questioning with regard to the suspect anterior tooth region finally resulted in the patient mentioning an occasional sensitivity under the upper lip, which the patient himself attributed to daily practice with the woodwind instrument and a possible overstressing of the lip musculature but he had never considered this to be due to an illness. [1–2] Endodontic treatment of tooth 11 five years previously was revealed in the case history. The root canal treatment was necessary because of a mechanical-traumatic dislocation of the tooth, which, after initial splinting and subsequent sensitivity checks, exhibited no positive vitality and thus no re-innervation/ vascularization of the damaged pulp. To better assess the suspected apical pathology, a three-dimensional X-ray diagnosis was performed, which showed the full extent of the bone defect: a sharply defined osseous translucency of approx. 2×3×1 cm in the frontal alveolar process of the maxilla with bony erosion to the incisive foramen and close relation to the endodontically treated tooth 11. Extensive vestibular loss of the alveolar process was dominant in the sagittal section (Fig. 2). Surgical rehabilitation The radiological findings correlated with the almost complete fenestration of the labial alveolar bone in the subsequent surgical therapy (Fig. 3). Due to the minimally invasive oriented tooth extraction using a piezosurgery device (mectron, Cologne) to separate the periodontal anchorage CASE STUDY
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