PMC10352529_01
Initial clinical situation showing the main patient complaint: inaesthetic diastemata.
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Indeed, the patient presented several diastemas as well as a mesioposition of canines before orthodontic treatment (Figure 1).
Initial panoramic radiography.
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In addition, the patient had asymmetry in her wisdom teeth with agenesis of tooth number 16, therefore, excluding the possibility of mesialising molars (Figure 2).
Initial profile teleradiography.
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Finally, the cephalometric analysis showed a skeletal Class III (angle ANB = 1 ) as well as a normodivergence with a tendency to hypodivergence (angle FMA = 23 ) (Figure 3).
Average smile line during extraoral examination and after orthodontic treatment.
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Post-orthodontic maxillary occlusal and frontal views showing maintained restorative spaces with palatal fixed retainer.
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Restorative spaces were about 7.5 mm and were maintained with fixed retainers and maxillary removable resin injected retainer in canine area (Figure 5).
Panoramic radiography at the end of the orthodontic treatment.
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But root axes were parallel to bicuspid ones, making the implant placement easier (Figure 6).
Sagittal views from the computed tomography (a) on the region of tooth number 6 with the implant prefiguration (blue) and (b) on the region of tooth number 11.
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On both sides, alveolar crest was narrow (7 mm) and presented a buccal undercut (Figure 7).
Immediate interim restoration of teeth numbers 6 and 11 using composite injected resin tray.
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Chemicals Groups, Hanau, Germany) were practiced, and the diagnostic setup for the final restoration was made in order to prepare a composite injected resin tray as interim restoration (Figure 8). Careful attention was taken to maintain space between gingiva and tray, in order to avoid healing interactions.
Pre- and post-operative illustrations: implant placement on the region of tooth number 11, implant platform at bone level with peripheric one, primary closure with resorbable sutures.
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Surgical healing screw (CCNSP, Zimmer Biomet, Palm Beach Gardens, FL, USA) was placed on each implant, and operative sites were primarily closed using resorbable sutures 4.0 (Vicryl , Ethicon) (Figure 9).
Pre-operative clinical situation showing a lack of keratinized tissue around implant in the region of teeth number 6 with a pigmented gingiva.
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Connective tissue graft during second stage implant surgery at D0 and D + 15.
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The two surgeries were practiced at the same time, and control visits were realized at 2 weeks and 3 weeks (Figures 11, 12, and 13).
Frontal view of second stage implant surgery: D0 and D + 15.
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The two surgeries were practiced at the same time, and control visits were realized at 2 weeks and 3 weeks (Figures 11, 12, and 13).
Occlusal maxillary view of second stage implant surgery: D0 and D + 21.
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The two surgeries were practiced at the same time, and control visits were realized at 2 weeks and 3 weeks (Figures 11, 12, and 13).
Frontal and occlusal views of the integration of temporary implant-supported crowns.
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Temporary implant directly fixed crows were tried, and occlusion was adjusted in order to obtain canine guidance in lateral movement but no interdental contact in static occlusion (Figure 14).
Management of peri-implant profiles in positions 6 and 11.
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With these temporary crowns, patient had function and aesthetic rehabilitation, and profile emergence was modeled with resin adjunction for the future definitive crowns (Figure 15).