logo 50 | the Camlog Partner Magazine logo 50 | the Camlog Partner Magazine 24 | Case study Case study | 25 Discussion Immediate restoration concepts are becoming increasingly popular and can be implemented successfully if certain criteria are taken into account. They represent a minimally invasive approach and are valued by patients due to fewer treatment sessions as well as a reduction in surgical procedures. Digital technologies improve diagnostics, analysis, planning and clear communication in the collaboration with tight deadlines between surgeons and dental technicians. Another advantage of immediate restoration concepts is the preservation of the peri-implant hard and soft tissue contours, also by employing pre-surgically fabricated customized temporary components with controlled healing. The individual PEEK gingiva formers can offer a new innovative approach by designing according to biological criteria, which eliminates the need for repeated surgery and time-consuming conditioning of the mucosal contour [7]. The concave submucosal design of the abutments is absolutely essential to provide sufficient space for the tissue to form a new biological width. Immediate restoration concepts require proactive planning. The surgical procedure should provide the framework for natural red and white esthetics. This means preserving the papillae and providing the required soft tissue support. The macrodesign of the implant system used should achieve predictable primary stability. Especially if the implant only attaches via the lower third in the residual bone and if there is only palatal bone contact. Arian's Story lively. View the patient case, filmed by rezotto production. 19. Immediately after tissue thickening, the individual PEEK gingiva former was placed for demonstration purposes. With its specific design, this promotes the natural attachment of the peri-implant mucosa while supporting the interdental papilla at the same time. In immediate implantation it provides the same soft tissue support as the temporary crown, and reduces the risk of overloading to protect implant healing. 20. If primary stability proved to be too low for immediate prosthetic restoration, a splint with integrated acrylic tooth would provide sufficient protection against overloading as an interim solution. This represents a compromise for an esthetic temporary solution. 21. In the presented case, the treatment team decided to insert a screw-retained temporary implant crown. This was largely excluded from function. The proximal contacts were also removed so that the adjacent teeth do not transfer any movement to the implant restoration during function. Close recall intervals were maintained during the healing phase. 22. One week after the surgical procedure, the soft tissue was free of irritation and created naturally. Due to the inserted connective tissue graft, the gingiva will attach to the connected tissue zone in a controlled manner. 23. The further measures for definitive reconstruction were able to be performed three months after surgery. 24. Removal of the temporary restoration revealed a stable and anatomically shaped soft tissue cuff. The concave shaped submucosal area is visible in the occlusal view. Minimal bleeding emphasizes implementation of the biological criteria for connective tissue accumulation in the area of the connected tissue zone. 25. The individual design of the PEEK impression post served to transfer the absolutely identical soft tissue situation to the master cast. In a three-dimensional study, Galibourg et al demonstrated that the soft tissue volume of the emergence profile collapses significantly when deprived of its support for 30 seconds [4]. 26. In his approach to perfect esthetics, Otto Prandtner, MDT, Munich, invested considerable time in analyzing the initial situation based on digital images according to the concept of "Digital Smile Design". This includes checking the tooth shade of the zirconium crown framework with so-called polarization filters. In this process, the chroma of natural teeth, the internal play of light and the characteristics are reproduced precisely [5,6]. 27. Four months after the surgical procedure, the definitive hybrid crown was placed. The crown design met all esthetic criteria, such as shape, shade, light guidelines and gingival adaptation. The chosen procedure contributed to maximum structural preservation without any scarring and an excellent esthetic outcome. 28. Emotion at its best. Arian was delighted with the successful esthetic implant reconstruction, the patient information and the competent care provided during the entire treatment process.
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