Immediate restoration in the esthetic zone
A clinical case report by Arndt Happe, Germany
The patient, a 30 year-old female in good general systemic health, had experienced unsuccessful endodontic treatment and a failed restoration of tooth 22 (Figs. 1, 2). The remaining root was insufficient for retention of a crown and showed periapical complications. The patient had a high lip line when smiling, showing both the papillae and the gingival soft tissue. There was loss of height of the mesial papilla of tooth 22 when compared to the contralateral site. The patient wished for replacement of this tooth 22 with an implant, in order to have an esthetically pleasing restoration. A decision was made in favor of a Straumann® Bone Level Tapered (BLT) Implant (14 mm, ∅ 4.1 mm).
Dr. med. dent.; PhD
Graduate of the University of Münster/Germany. Post-graduate program in Oral Surgery as a resident at Prof. Khoury`s Dental Clinic, Germany . Private practice in Münster, since 2000. Degrees in Implantology and Periodontology from the corresponding German Associations. Assistant Professor at the University of Cologne (Prof. J.E. Zöller) since 2013.
Implant placement was done with a transmucosal approach by preparation of the bony cavity without raising a flap (Fig. 3). The buccal plate was intact, which was a prerequisite for immediate implant placement. The implant was placed towards the palatal side of the socket, leaving a gap of 2 mm to the buccal plate. The gap was filled with a xenograft of bovine bone particles. The implant showed very high primary stability, which allowed for immediate provisional restoration. The lab-fabricated drilling template also served as the suprastructure for constructing the provisional crown which was adjusted to be out of the patient’s occlusion (Fig. 4). The buccal mucosa was augmented with a CTG (connective tissue graft) harvested from the palatal mucosa, which was inserted in a pouch (Figs. 5, 6) to bulk out the buccal soft tissue contour.
After three months of soft and hard tissue healing (Figs. 7, 8), a retrievable screw-retained crown consisting of veneered monocrystalline zirconia on the Straumann Variobase® abutment was used. The crown was constructed without applying pressure to the soft tissue, thus creating a favorable emergence profile. Four months after immediate implant placement and final restoration (Figs. 9, 10), the final periapical radiographic appearance shows healthy tissue integration (Fig 11). The patient was satisfied with both her extra-oral and intra-oral appearance after treatment (Fig. 12).
The BLT implant with its macro- and micro-rough surface and optimal biocompatibility satisfies not only immediate treatment requirements, but also meets the patient’s esthetic expectations.
The new Straumann® Bone Level Tapered Implant shows great primary stability and smooth drilling with the BLT instruments. The insertion is fast, easy and precise due to the design of the implant transfer piece, which allows for good control of vertical positioning. The ideal macro design of the implant combined with its biological and mechanical concept of platform switching and conical connection makes it a great choice of an implant to use in such cases.