Indication 2, Case 1

Extended edentulous space maxilla

Hans-Peter Weber, Associate Professor and Chair,
Department of Restorative Dentistry,
Harvard School of Dental Medicine, Boston MA, USA

Stefan Neeser CDT,
Tufts University, School of Dental Medicine, Boston MA, USA

This case demonstrates a prosthodontic solution to a problem resulting from unfavorable implant placement in the esthetic appearance zone. The 23 year old Caucasian male patient had lost the upper left central and lateral incisors in an accident. Unfortunately, the concomitant alveolar defect was not sufficiently restored prior to implant surgery, requiring the replacement of the missing hard and soft tissues with prosthodontic means. Use of modern materials, proper prosthesis design regarding esthetics, function and access for maintenance are key to success here, together of course with a motivated and cooperative patient.

	Protruding implant axes and, more aggravating, implant shoulders in positions too apical in relation to the soft tissue emergence of the neighbor teeth.

	Master cast with octa-abutment analogs and soft tissue modeling in implant area; impression was obtained via non-repositional octa impression copings.

	Try-in of diagnostic set-up / wax-up in labial view with wax modellation of anticipated tissue masking.

	Pleasing esthetic appearance of set-up. Note patient's low smile line which is a helpful adjunct for the successful handling of a situation like this one.

	Tooth set-up is indexed with silicone putty material on master cast.

	Non-octagonal plastic capings are used and trimmed to adequate length to serve as burn-out patterns for the planned mesio-structure.

	Completed wax-up of mesio-structure including two medium size tube-and screw housings.

	Mesio-structure at try-in in patient; passive fit is verified as well as superfloss accessibility of inter-implant area.

	Lingual view of mesio-structure demonstrating tube-and-screw holes.

	Waxing of supra-structure frame designed and dimensioned for adequate support of ceramic materials in dental and gingival areas.

	Supra-structure frame repositioned on master cast after casting and finishing.

	Shade selection for teeth and gingival tissues using "Classic Gingiva®", Ivoclar, Schaan, FL.

	Final restoration on master cast.

	Close-up of completed restoration in lateral view. Note the overall convex design geared to facilitate oral hygiene in the tissue facing aspects.

	Close-up view of soft tissue facing areas of restoration.

	Labial and lingual intraoral close-up views of completed restoration. Tube-screws inserted.

	Completed restoration in the esthetic appearance zone.

	Access for oral hygiene measures with superfloss is maintained.

	Follow-up radiograph three and a half years after insertion of prosthesis demonstrates stability of result. ITI solid screw implants Ø 3.3, 10 mm length.