Lateral maxillary incisor implant

Fig. 1: Agenesis of 22, opening of orthodontic space.

Fig. 2: Line of intermediate smile. The smile uncovers the papillae and reaches the collar of the incisors (12 and 22 are supported by implants).

Fig. 3a: Average forms, types and dimensions of the lateral incisor according to Papathanassiou.[6]

Fig. 3b: Proximal view photographs showing 10 anatomical variants of lateral maxillary incisors described by the author.[6]

Fig. 4: According to Levin, following the golden ratio, the width of the lateral incisor y = 0.62 x and, for Preston, it is 0.66 x (images from Papathanassiou).[6]

Fig. 5: Evidence of bone deficit at 22 (case shown in Fig.1).[6]

Fig. 6: Simulation of location of 3mm[6] implant in cross section (case shown in Fig.1).[6]

Fig. 7: Evidence of radicular convergence.

Fig. 8: Orthodontic layout of implant corridor.

Fig. 9: Diastemas created around a riziform tooth to obtain a space of 6mm.

Fig. 10a: Centered location of zenith of 22 (a) (arrow) to be taken into account when making the crown 12 (b).

Fig. 10b: Centered location of zenith of 22 (a) (arrow) to be taken into account when making the crown 12 (b).

Fig. 11: Cortical graft in place, shaped to support future papillae (case as shown in Fig. 1).

Fig. 12: X-ray result, compare with Fig. 6.

Fig. 13: Clinical outcome 5 months after the graft. Compare with Fig. 11.

Fig. 14: 3 mm diameter Nobel Active implant.

Fig. 15a: Papillary view (b) X-ray view (a), 2 years after the insertion of the implant.

Fig. 15b: Papillary view (b) X-ray view (a), 2 years after the insertion of the implant.

Fig. 16: Mobile Anyray 2 (Vatech) X-ray generator.

Fig. 17: Intraoperative X-ray, Precision Drill inlay (left on picture) and in situ (right on picture).

Fig. 18: Clinical outcome 5 months after the graft. Postoperative X-ray Nobel Active 3/0 implant and 15° abutment in place.

Fig. 19: Initial situation.

Fig. 20: De-epithelialisation of a palatal flap into a diamond shape.

Fig. 21: Unfoldment of palatal flap, vestibular edge.

Fig. 22: Creation of flap envelope, Swann-Morton blade through the envelope. SM 63, inlaid with transparency.

Fig. 23: Passage of suture through the envelope.

Fig. 24: The palatal flap is folded into the vestibular envelope using a suture thread.

Fig. 25: Tissue integration with ceramic crown.

Fig. 26: Vestibular bulge obtained with modified flap.

Fig. 27a: Clinical and X-ray views, vitroceramic in place.

Fig. 27b: Clinical and X-ray views, vitroceramic in place.

Fig. 27c: Clinical and X-ray views, vitroceramic in place.

Fig. 28: Initial incision creating two vestibular half papillae.

Fig. 29: Suture of half papillae (situation in Fig. 1).

Fig. 30: De-epithelialisation tuberosity graft.

Fig. 31: Insertion of connective graft buried under the papillae.

Fig. 32: Clinical outcome in a case of gummy smile.

Fig. 33: Insufficient soft tissue thickness alters the chromatic outcome.

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