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logo 19 • CAMLOG Partner Magazine • December 2018 12 PD Dr. Gerhard Iglhaut, Memmingen IMPLANT ESTHETICS INTERPLAY BETWEEN SUPERSTRUCTURE AND SOFT TISSUE Fig. 1: The initial situation revealed inflammatory tissue in the anterior region of the upper jaw. Fig. 3: The DVT showed clear apical resorption of tooth root 11 and apical lesions on all three anterior teeth. An important interface for implant-prosthetic restorations in the esthetic region is the emergence profile of the superstructure. In addition to correct implant positioning, an adequately and anatomically shaped jawbone is therefore just as essential as a thick, fixed gingiva for a long-term stable reconstruction – both from an esthetic and biological point of view. The following clinical case presentation describes a treatment concept following anterior tooth trauma with immediate implant placement as well as hard and soft tissue augmentation [1]. Immediate implant placement is a challenge for the treating team, especially in the esthetic zone. Despite high survival rates, the risk of postoperative complications is relatively high [2]. The reason being resorption of the periimplant hard tissue and subsequent buccal recession of the soft tissue. This often leads to the exposure of titanium surfaces and consequently to considerable esthetic impairment. Furthermore, these defects are rather difficult to correct. A proactive treatment protocol taking which takes the biological remodeling processes into consideration is indispensable for the reconstruction or preservation of stable peri-implant tissue. Patient’s medical history In January 2015, a 49-year-old man with complaints in the anterior region of the maxilla presented in the practice. He stated that he had been in an accident over 20 years ago and had suffered a trauma in the anterior region. The anterior teeth 12 and 21 were treated endodontically alio loco and restored with post abutments and ceramic veneered crowns. Over time, both teeth had been resected several times. During intraoral examination, a loosening of teeth 12, 11 and 21 was observed. The DVT showed intact alveoli on 12 and 21, partial bone loss of the facial lamella in region 11 as well as a distinct apical resorption of tooth root 11. All three anterior teeth exhibited apical foci (Figs. 1 to 6). Therapy planning The prognosis for the preservation of the above mentioned anterior teeth was judged to be very unfavorable. Consequently, the resulting indication implied extraction of teeth 11, 12 and 21. For esthetic reasons, a bridge reconstruction on two implants in region 12 and 21 was planned. Treatment with immediate implantation was chosen to counteract the natural healing of the alveolar socket, which may result in a flattening of the interdental papillae and the facial contour of the alveolar process. By considering the biological remodeling processes and adequate hard and soft tissue augmentation, an esthetic result can be planned proactively. With three implants, the required minimum distance of 4 mm between the implants (Ø 3.8 mm) would not have been given. In addition to the height of the alveolar bone, the thickness of the vestibular lamella is a prerequisite for creating an ideal emergence profile. The bone also supports and stabilizes the harmonious contour of the gingival profile – the criterion for the long-term success of an esthetic reconstruction. To preserve esthetics, the positioning of the implants is just as important as the consideration of biological factors. For sufficient stability of the buccal bone wall, the circular bone in the region of CASE STUDY Fig. 2: During the intraoral examination the loosening of the multiple resected anterior teeth 11, 21 and 22 was ascertained.