Indication 4 Case 1

Micael Hansen (CDT)
Clinic for Oral, Maxillofacial and Plastic Surgery
Katharinenhospital
Klinikum Stuttgart

Introduction
A 29-year-old patient was referred to our clinic for implant evaluation in area 21. As an adolescent she had experienced a dental trauma of her left central incisor. The trauma eventually led to pulp necrosis and endodontic treatment. Clinical and radiological examination made clear that extraction was inevitable at this point and that replacing the tooth with an implant would be the treatment of choice.

	1 The radiograph taken prior to treatment shows a large periradicular translucency in area 21 which is also responsible for severe bone loss at the neighboring lateral incisor. Periodontal and bony healing was not to foresee, so a staged approach was preferred with further measurements depending on the situation a few months later..

	2 Occlusal view on area 21: severe loss of width of the alveolar bone and shrinking of the soft tissues.

	3 Surgical site six months after extraction of the central incisor: a partial reattachment on the lateral incisors root surface and a severe atrophy of the alveolar ridge have to be noted. The incomplete periodontal recovery nevertheless compromises augmentation and future implant placement.

	4 Autogenous cortico-cancellous bone chips are used to fill the periodontal defect. A block graft furthermore contributes to 3-dimensional reconstruction of the atrophic site.

	5 The edges are rounded with a bur and additional bone chips are placed on top and around the block graft.

	6 In the postoperative panoramic radiograph the donor site in area 38 and its relationship to the alveolar nerve are clearly identified.

	7 Occlusal view on the augmented alveolar ridge six months later.

	8 Good incorporation of the grafted bone.

	9 ITI SLA solid screw implant inserted.

	10 Radiographic control 3 months after implant placement.

	11 Ceramic abutment in the maxillary master cast.

	12 The individually shaped ceramic abutment harmoniously supports the soft tissue margin.

	13 Occlusal view of the screw-retained ceramic abutment.

	14 Intraoral aspect after cementation of the ceramic crown. Healthy periimplant soft tissue conditions and individualized emergence profile.

	15 Harmonious extraoral appearance after restauration.