logo 50 | the Camlog Partner Magazine logo 50 | the Camlog Partner Magazine 22 | Case study Case study | 23 8. The digital design was passed to the DEDICAM manufacturing service. There, the models were manufactured using the 3D printing process, as were the drilling template, gingiva former and impression post, as well as the temporary implant crown. These were delivered after four days and were available for surgical intervention in the dental practice. The deep-drawn splint with acrylic tooth was on hand for temporary restoration in case primary stability proved insufficient. 9. On the day of surgery, the anterior tooth was gently extracted. To retain the surrounding tissue structures, extraction was performed minimally invasive. Due to the fistula, the vestibular lamella was fenestrated. After removal of the ceramic crown, the focus was placed on preserving the intact soft and hard tissue structures. Tooth 21 was removed with a microscalpel, periotomes and desmotomes, and the fistula tract was freshened with the microscalpel. 10. During root extraction, the inflammatory tissue adhered to the root tip, also no bone fragments were visible on the surface - suggesting that the buccal lamella had remained intact. In the case of late implantation, the root would be cleaned and sent to the dental laboratory for adaptation of an anatomical emergence profile to explore measures for tissue support in the analog world. 11. De-epithelialization of the alveolus was performed with diamond balls as well as with the scalpel blade. This is critical for complete healing of the tunnel connective tissue graft. 12. The printed SMOP drilling template was inserted and stability of the position was checked. The skeletonized design and the intricate construction provide a good overview of the surgical site. This permits using a minimally invasive surgical technique, does not interfere with the cooling process and does not exert pressure on the soft tissue due to the previously selected positioning of the sleeve. 13. The implant site was prepared according to protocol using the drills of the PROGRESSIVE-LINE Guide System. And although the drill is guided very well in the drill sleeve, care should be taken to align the drill with the palatal alveolar wall, especially in the case of immediate implantation. Autologous bone chips can be collected with careful preparation and subsequently used for augmenting the buccal gap. To provide correct three-dimensional placement, the implant was inserted through the drilling sleeve until the insertion post was seated on the sleeve. Due to the apically conical implant area, the implant achieved a sufficiently high primary stability of 35 Ncm in the residual bone. This allowed the concept of temporary immediate restoration to be pursued further. 17. To support peri-implant tissue healing and dense stabilization of the blood coagulum, the treatment protocol called for thickening of the soft tissue. For this purpose, a connective tissue graft was removed from the palate at region 24/25 and de-epithelialized extraorally based on the technique according to Zucchelli [3]. 18. With the aid of positioning sutures, the graft was pulled into a previously prepared envelope and placed precisely in the position envisaged beforehand in the subgingival design of the suprastructure. 15. Precise alignment of the inner implant geometry is essential for the correct fit of the individual components fabricated prior to surgery. This is done by aligning the orientation line on the insertion post/insertion instrument with the marking on the drilling sleeve. 16. The jumping distance - the cavity between the buccal bone wall and the implant - was filled with autologous bone (collected during implant bed preparation with the guide drills) for resorption protection and stabilization of the vestibular lamella as well as for supporting the soft tissue. 7. The Personalized Tissue Support Concept envisages that the customized gingiva former or temporary restoration ensures preservation of the existing soft tissue architecture, avoids compression of the soft tissue and leaves sufficient space for stable tissue regeneration. [2]. The subcritical concave designed area offers space for a stable blood coagulum as well as a possibly required connective tissue graft.
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