Indication 2 Case 2

Extended edentulous space maxilla


Restorative Dentist: Jean Paul Martinet DDS
Surgeon: Pedro Tortamano Neto DDS, Luiz Otavio Camargo
Technician: Julio Yamanouchi

	1 and 2 Female patient suffering from a car accident, which resulted in traumatic loss of both superior central incisors.

	3 Main incision deflected 1 mm for palatine aiming the maintenance of more quantity of buccal tissue.

4 and 5 The bone crest at the implant site was flattened with a tungstenium burr to provide a plateau. The bone between the two implant beds was not flattened in order to be an artificial sept which will support the future papillae between the two futures implant-supported crowns. In case of all bone crest be flattened, it would be very difficult to succeed an ideal contour of soft tissue, living a "black hole" between the crowns.

	6 Following the directives of the template to prepare the implant bed, locate the retention screws' emergency profile of the futures crowns and also due to the buccal bone resorption we chose to hollow cylinder with 15 degree angled 3,5 x 12 mm Esthetic Plus.

	7 The implant shoulder must be placed 1 mm below neighbor's teeth union line cement-enemal giving a correct emergency profile to the future's crowns. To improve performance, the implants body widens trumpet - like at the top to 5 mm diameter at the shoulder, a form similar to the cervical preparation of a natural tooth to accept a crown.

	8 Healing caps "esthetic plus" were used allowing, to reposition the flap recovering partially these screws beveled buccally.

	9 After 3 months, we chose the octa abutement to make the screwed retained prosthesis, due to the union line crown - implant depth.

	10 After conventional impression using the prefabricated aluminium impression coping, temporary crowns were prepared over the antirotational prefabricated titanium component for provisional.

	11 and 12 Using th acrylic resin incremental technique, the emergency profile was configurated conditioning the mucous tissue contorn at cervical region.

13 To transfering the actual implants position to the master cast and even the actual mucous tissue contorn conditioned by the temporary crowns manipulation, it was necessary to impression using these temporary crowns. As the prefabricated titanium elements fit perfectly for octa abutement and implant shoulder, allowed an accuracy impression, just changing the retention srews for other taller than these.

	14 Impression using individual tray and temporary crowns as transfers.

	15 Impression. Notice that the temporary crown stayd into the impression.

	16 Cast prepared with artificial gingiva.

	17 and 18 Perfect soft tissue reproduction obtained with impression technique, which allowed the laboratory technician to manufacture the definitive crowns with the ideal emergence profile.

	19 RX after 2 years, showing the bone margin.

	20 and 21 Actual clinical status, with definitve crowns exhibiting natural aspect and patient total satisfaction.