PMC3870648_01
Initial radiograph of maxillary left central incisor.
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The radiographic examination showed an oversized cast post and core, which occupied three quarters of the root's length (Figure 1).
The maxillary left central incisor with a metal ceramic restoration. Its margins were placed on the underlying cast post and core.
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The clinical examination revealed that the metal ceramic restoration was fractured at the buccal marginal area, it had a surface texture that did not match that of the adjacent natural teeth, it was rather opaque, and its margins were placed on the underlying cast post and core instead of on sound tooth structure (Figure 2).
Atraumatic extraction of the maxillary left central incisor.
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An atraumatic tooth extraction was then performed with the use of a periotome, taking extra care to preserve the buccal plate (Figure 3).
Placement of an Osseotite NT implant in the extraction socket. The platform of the implant was placed 2 mm apically to the cementoenamel junction of the right maxillary central incisor.
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The platform of the implant was placed 2 mm apically to the cementoenamel junction of the right maxillary central incisor (Figure 4).
Buccal bone deficiency filled with bovine bone material.
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A bone deficiency remained buccally and it was filled with bovine bone mineral (Bio-Oss Collagen, Geistlich) (Figure 5).
Initial provisional PMMA acrylic resin crown.
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The sutures were removed after 10 days (Figure 6).
The impression coping was modified with light-polymerizing resin material to register the peri-implant soft tissues.
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Light-polymerizing resin material (Liquidam; Discus Dental, Culver City, CA) was injected around the impression coping and was immediately polymerized with a UV polymerizing unit, preventing the soft tissues from collapsing onto the impression coping (Figure 7).
The impression coping into the polyether impression material used. Note the amount of light-polymerizing resin material added to support the soft tissues.
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fig8
A plastic stock tray and polyether material (Impregum, 3M/ESPE, Seefeld, Germany) were then used for the impression (Figure 8).
A new provisional crown was fabricated with light-polymerizing resin, in order to better support the soft tissue contours mesially and provide a better esthetic result.
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Tokyo, Japan) (Figure 9). This provisional restoration was fabricated in order to support better the soft tissue contours mesially and provide a better esthetic result (Figure 10).
Clinical view of the new provisional crown.
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Tokyo, Japan) (Figure 9). This provisional restoration was fabricated in order to support better the soft tissue contours mesially and provide a better esthetic result (Figure 10).
A definitive screw retained metal ceramic restoration was fabricated 6 months after implant placement.
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Porcelain was applied and baked in the traditional manner (Figure 11).
Final radiograph obtained at 6 months after implant placement.
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After the delivery of the definitive restoration (Figures 12 and 13), the patient was followed every 4 months for the next year.
Clinical photograph of the definitive metal ceramic crown.
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After the delivery of the definitive restoration (Figures 12 and 13), the patient was followed every 4 months for the next year.