Fig. 1: The female patient wanted new restorations with bright, natural-looking crowns in regions 12 to 22.
Fig. 2: Tooth 11 could not be saved and was to be replaced with an implant.
Fig. 3: The photographs and situation models were analysed in terms of aesthetics, and all details diligently recorded on the relevant form.
Fig. 4: After removing the temporary crowns on teeth 12 and 21, the supra-alveolar periodontal attachment of tooth 11 was severed with a periotome.
Fig. 5: The root was extracted after atraumatic removal of the crown. The buccal bone lamella connected to the root surface was lost during the process.
Fig. 6: The palatal margin of the alveolus was marked with the pilot drill through a deep-drawn guide prepared in the laboratory.
Fig. 7: When inserting the implant, the surgeon oriented himself along the palatal bone wall.
Fig. 8: The implant was palatally displaced in the correct position; the buccal bone lamella no longer existed.
Fig. 9: The position of the implant in the dental arch was checked with the aid of the guide.
Fig. 10: A retromolar bone cylinder was harvested with a trephine drill to obtain autologous bone for augmentation of the buccal lamella.
Fig. 11: The space between the implant and buccal soft tissue was filled with a mixture of autologous bone and bovine bone replacement material.
Fig. 12: In order to obtain optimal buccal contours, a connective-tissue graft harvested from the palate was drawn under the soft tissue and sutured.
Fig. 13: The temporary bridge was cemented with the healing cap without contact with the pontic.
Fig. 14: The sub-crestal bone position and good cervical join of the temporary bridge are shown on the post-operative X-ray.
Fig. 15: Good healing and successful integration of the connective-tissue graft are evident one week after immediate implantation. The white-yellow deposits are fibrin.
Fig. 16: After a three-month healing period, the implant was successfully osseointegrated and the soft tissue had stabilised for final impression taking.
Fig. 17: The peri-implant soft tissue is well formed and largely irritation free under the temporary bridge.
Fig. 18: Good perfusion of the peri-implant soft-tissue well can be observed. Buccal tissue thickness exceeds 3 mm.
Fig. 19: Impression taking of the prepared teeth and the implant.
Fig. 20: Following reinsertion of the temporary bridge, excess soft tissue was observed in the area of the implant (position 11).
Fig. 21: Individual stumps made of super-hard plaster with grooves to prevent rotation were fixed in the impression with instant adhesive.
Fig. 22: Preparation of the master model. The wax pins served as access to the stumps on the master model.
Fig. 23: The precise periodontal and peri-implant soft-tissue situation was represented on the master model.
Fig. 24: The marginal border of the planned implant crown was transferred to the plaster surface.
Fig. 25: The peri-implant emergence profile was expanded and the papillae sharpened to provide a harmonious gingival profile.
Fig. 26: Optimal hold of the wax-up during try-in through filled implant interface.
Fig. 27: Overview of abutment options (from left: CONELOG Esthomic abutment (1.5 to 2.5 mm gingiva height) prior to and after customising, the CONELOG Titanium base CAD/CAM.
Fig. 28: The Esthomic abutment, extended with a bonding aid, shows the palatal positioning of the access channel.
Fig. 29: Customising the primary abutment ensures sufficient coating strength of the zirconium oxide abutment.
Fig. 30: The titanium base and the completed model of the secondary abutment were scanned in the laboratory. Buccal space was left for the planned pressed ceramic veneer.
Fig. 31: The sintered abutment left without and right with fluorescent solution treatment.
Fig. 32: Firing of a highly fluorescent, etchable zirconium oxide veneer ceramic. The shape of the abutment was optimised prior to modelling the press cap.
Fig. 33: The layer thicknesses for veneering the pressed ceramic caps were checked with the aid of the vestibular, twice-divided silicone index.