PMC8052180_01
Implantation of one-piece implant (clinical procedure): (a) clinical situation presurgically; (b) elevation of full-thickness flap with preservation of peripheral periodontium at adjacent teeth; (c) implant bed preparation, predrilling instrument; (d) processed implantation site using drilling protocol; (e) placement of one-piece implant with spatial orientation aligned to the natural dentition; (f) apical repositioned and sutured flap; (g) clinical situation one week after surgery; (h) clinical situation 12 weeks after surgery; (i) single crown prosthetic restoration with mesial pontic design; (j) presurgical radiographic control, calibration ball for planning of implantation; (k) postsurgical radiograph taken directly after implant placement; (l) radiographic control nine years after treatment.
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Bone sounding was performed to assess the defect morphology presurgically and provide sufficient information for the design of the flap (Figure 3(a)). The flap was gently elevated to the buccal site before implantation (Figure 3(b)). After implant-bed preparation using the drilling-protocol, a one-piece implant (FairOne ; diameter: 5.0 mm and length: 10 mm) was placed (Figures 3(c) and 3(d)). The flap was apically repositioned and sutured in a tension-free condition (Seralon , D1S 15, 5-0, Serag-Wiessner, Naila, Germany) providing a sufficient buccal preservation of at least 4 mm of KG at the healing site (Figures 3(e) and 3(f)). After one week of nonsubmerged healing, the surgical site showed proper conditions showing no signs of recession formation (Figure 3(g)). After 12 weeks of implantation, the surgical site showed perfect conditions for single-tooth replacement with a thick KG around the implant (Figure 3(h)). The crown was designed with a mesial cantilever achieving a pontic design in order to allow for a proper interdental cleaning (Figure 3(i)). The radiographic evaluation showed no signs of bone resorption and a biological stable situation even after nine years of implant treatment (Figures 3(j)-3(l)).
PMC8052180_02
Prosthetic workflow for the one-piece implant FairOne : (a) clinical situation presurgically presenting sufficient keratinized gingiva around implant site; (b) clinical situation after healing period of 12 weeks; (c) impression with double-mix technique; (d) laboratory processing, master cast with implant analog, and gingival mask; (e) clinical preparation using a transfer coping for occlusal adaption; (f) clinical situation with cemented implant crown (mesial pontic design); (g) postoperative radiographic control after delayed implantation; (h) radiographic evaluation four months after prosthetic restoration; (i) radiographic control nine years after implant treatment.
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The clinical situation after atraumatic extraction showed no signs of inflammation and sufficient quantity of soft tissue (Figure 4(a)). In the posterior region, no provisional restoration was necessary during the healing phase, since there is no additional surgery for uncovering of the implant and no abutment dis-/reconnection shaping of the emergence profile occurred early during the initial healing phase on the continuous rough surface (Figure 4(b)). Additionally, the baseline of the bone crest in the mesial and distal direction is documented (Figure 4(g)). The impression could be performed using a double-mix technique with a polyether (Impregum , 3M, Landsberg am Lech, Germany) (Figure 4(c)). Within the laboratory process, a master cast in conjunction with an implant analog and gingival mask was used adjusting the prosthetic restoration and ensuring that the emergence profile of the crown is optimally contoured (Figure 4(d)). This could enable the surgeon to realize defined adjustments for the prosthetic head prior to the crown fitting and cementation process (Figure 4(e)). The final restoration was placed using a metal-supported ceramic crown (Figure 4(f)). After 10 weeks of implant treatment, a slight loss in bone height adjacent to the implant in the mesial and distal direction could be observed but no excess of cement is evident (Figure 4(h)). Nine years after implant placement, remineralisation and formation of new bone at the peri-implant interface can be observed presenting stable biological conditions (Figure 4(i)).
PMC8052180_03
Soft-tissue augmentation in the region of the planned implantation: (a) clinical situation presurgically presenting small alveolar crest and reduced width of keratinized gingiva around implant site; (b) augmentation of free gingival graft at the buccal aspect; (c) clinical situation six weeks after healing; (d) postoperative clinical situation after implantation of two one-piece implants, flap closure; (e) clinical situation after 12 weeks of transgingival healing; (f) prosthetic restoration six months after implantation, cemented single crowns; (g) radiographic control after implantation; (h) postsurgical radiograph taken directly after cementation of single crowns; (i) radiographic control nine years after implant treatment.
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The keratinized tissue around the targeted implant site was reduced (Figure 5(a)). After augmentation of a free gingival graft (FGG) harvested from the palate, the buccal aspect of the recipient site could be notably expanded to assure thick gingival conditions with keratinized tissue (Figures 5(b) and 5(c)). A tension-free suturing was conducted (Seralon , D1S 15, 5-0, Serag-Wiessner, Naila, Germany) providing a sufficient buccal preservation of at least 4 mm of KG at the healing site (Figure 5(d)). After implantation, postsurgical radiographs were taken with a proper parallel technique to monitor the bone crest and correct positioning of the implants (Figure 5(g)). After a healing period of thirteen weeks, successful periodontal integration could be documented (Figure 5(e)). Ivoclar Vivadent, Schaan, Lichtenstein) to support osseointegration. Implants were restored with metal-supported ceramic crowns to allow for full recovery of the masticatory function within the jaw segment (Figure 5(f)). To control for excess cement and proper positioning of the crown, a radiographic control was performed (Figure 5(h)). Nine years after implant placement, a stable osseous situation could be documented and the clinical situation does not indicate the presence of peri-implantitis (Figure 5(i)).
PMC8052180_04
Delayed implantation of one-piece implant in esthetic zone: (a) clinical situation after extraction and socket preservation with soft-tissue augmentation; (b) clinical situation presurgically presenting small horizontal dimension of alveolar ridge; (c) reflection of connective tissue pedicle using roll technique with implant placement; (d) initial radiographic situation with hopeless tooth; (e) clinical situation after implant placement; (f) suturing and fixation of connective tissue at the buccal site; (g) healing after one week and suture removal, immediate provisional restoration (occlusal view); (h) radiographic control after implantation; (i) healing period one week after implantation with provisional restoration (buccal view); (j) prosthetic restoration with single crown four months after healing; (k) clinical situation 10 years after intervention; (l) radiographic control 10 years after implant treatment.
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The tooth had a hopeless prognosis but the surrounding bone was assessed to be appropriate for implantation (Figure 6(d)). Subsequent to minimal invasive extraction, socket preservation with soft-tissue augmentation by means of a free gingival graft was conducted (Figure 6(a)). Healing occurred uneventful, and soft-tissue dimensions could be preserved (Figure 6(b)). The connective tissue was prepared from the palatinal area and rotated to the buccal site of the implantation site (Figure 6(c)). After implantation of the one-piece implant (FairOne ; diameter: 5.0 mm and length: 10 mm) (Figure 6(e)), the flap was repositioned and tension-free suturing was secured (Figure 6(f)). A temporary provisional composite crown for esthetic demands was delivered directly after implantation (Figure 6(g)). After implantation, postsurgical radiographs were taken with a proper parallel technique to monitor the bone crest and correct positioning of the implants (Figure 6(h)). One week after uneventful healing, sutures could be removed with interdental papilla remained well preserved (Figure 6(i)). The composite crown was replaced with a metal-supported ceramic crown, and after four months of healing, stable soft-tissue conditions without recession formation could be documented (Figure 6(j)). The clinical and radiological situation remained stable even 10 years after intervention with a good prognosis (Figures 6(k) and 6(l)).
PMC8052180_05
Immediate restoration of one-piece implant in esthetic zone: (a) clinical situation after fracture of left central incisor, (b) atraumatic extraction of remaining tooth, (c) complete extraction and cleaning of alveolar ridge, (d) clinical situation after immediate implant placement, (e) provisional restoration, reattachment of implant crown for right central incisor, (f) prosthetic restoration with single crown five months after healing, (g) initial radiographic situation with hopeless right central incisor, (h) radiographic situation before implantation of left lateral incisor, (i) radiographic control after implantation of first right incisor, (j) radiographic control after immediate implantation of left central incisor, and (k) radiographic situation nine months after immediate implant placement for left central incisor.
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The clinical situation does not support any symptoms of severe infection or traumatic damages of the surrounding soft tissue (Figure 7(a)). These served as a baseline image to monitor the height of the bone to implant contact for further diagnosis and prevention of peri-implantitis (Figures 7(g) and 7(h)). During atraumatic minimal invasive extraction, debonding of the neighboring implant crown took place presenting healthy soft-tissue conditions (Figure 7(b)). After complete extraction, a precise cleaning and rinsing of the extraction socket was conducted (Figure 7(c)). Immediate placement using a one-piece titanium implant (FairOne ; diameter: 4.2 mm and length: 13 mm) was performed, and complete wound closure could be carried out establishing primary stability (Figure 7(d)). Appropriate design of the provisional restoration was considered to preserve soft-tissue stability around the implants during healing period (Figure 7(e)). Following healing, a temporary metal-supported ceramic crown could be provided five months after implant therapy (Figure 7(f)). The radiographic control showed stable osseous conditions for the one-piece implant of the maxillary first central incisor (Figure 7(i)). The preceding interventions using FairOne  at adjacent teeth are clinically and radiologically inconspicuous (Figure 7(j)). The radiographic control of nine months after immediate implantation revealed bone stability for all one-piece titanium implants (Figure 7(k)).