Indication 8, Case 1

Single tooth gap mandible

Daniel Hess, Dr. med. dent
St. Gallen / Switzerland
Alwin Schoenenberger CDT,
Glattbrugg/Switzerland

	Clinical situation of a 16-year-old female patient at initial examination. She was referred for implant evaluation in areas 35 and 45 where, at both sites, the second premolar teeth were congenitally missing. The patient's plaque control was inadequate. Clinical signs of gingival inflammation are obvious, in particular, in the upper front segment.

	Lateral view of the patient's right side. Tooth 85 is still present. Due to ankylosis, its occlusal surface is located in a much too apical position when compared to the neighboring permanent teeth. Teeth 14 and 15 are slightly elongated. Otherwise, the occlusal relationships can be considered as adequate.

Lateral view of the patient's left side. The occlusal relationships are less favorable than on the opposite side. Note in particular the absence of occlusal contacts for teeth 22, 23 and 24. In addition, a cross-bite situation is present, except for 27 and 37. The treatment plan provides the extraction of the ankylotic deciduous molars and their replacement with implant-borne single crowns. In addition, orthodontic therapy will be undertaken.

	Occlusal view of area 35, eight weeks after tooth extraction. The width of the edentulous crest is almost entirely preserved. Soft tissue healing has been completed. At this time, the implant will be inserted.

	Periapical radiograph of the prospective implant site. Based on this evaluation, the placement of a 10 mm full-body screw implant is possible. The former tooth socket of the extracted deciduous molar is still visible. Note the distal migration of tooth 34.

	Clinical situation after implant placement and wound closure. Surgery was performed according to the standard procedure for posterior segments. The implant was fitted with a big closure screw.

	Occlusal view 3 months after implant insertion. Healing progressed uneventfully. In the bucco-lingual direction, the implant is almost perfectly aligned with neighboring teeth; a correct three-dimensional implant positioning is essential for the fabrication of harmoniously shaped prosthetic suprastructures.

	Radiographic control prior to abutment fixation. Tissue integration is considered excellent.

	Clinical situation after abutment fixation. The implant was fitted with a solid abutment of the new transfer system. The flat surface serves as an antirotational element. To date, single tooth gaps, small edentulous spaces and free-end situations are most usually treated with cemented suprastructures.

	A transfer coping was seated on the implant shoulder (snap-on mechanism) and its precise fit checked by a rotational movement.

Bild fehlt	A color-coded repositioning cylinder was oriented according to the flat surface of the solid abutment and completely inserted into the transfer coping.

	Impression was taken. The selection of the appropriate laboratory analogue is easily possible due to the color-coded system.

	Working cast with integrated laboratory analogues.

	Wax-up of the two premolar units. Long-term provisional restorations are planned because the growth of the patient's facial skeleton has not yet been completed.

	A silicone key serves as a mold for the fabrication of the provisional restorations. The use of prefabricated copings that are adjusted to their correct height will facilitate laboratory procedures and ensure a perfect marginal fit.

	The surface of the coping is roughened to ensure proper retention for the overlying acrylic material.

	Provisional restoration after retraction of the silicone key. Excess resin has to be removed. Minor adaptations are necessary to adjust occlusal contacts.

	Final view after application of a surface varnish..

	Close-up view of the provisional restoration prior to cementation. Note in particular the emergence profile of the suprastructures and the integrity of the marginal areas

	The long-term provisional restoration is harmoniously integrated within the dental arch

	Occlusal overview after completion of prosthetic therapy for site 45 and ....

	... site 35, respectively. The patient is now ready for orthodontic therapy.

	Periapical radiograph of site 45 at the end of therapy. Note the excellent marginal bone level around the implant.

	Peri-apical radiograph of site 35, documenting good osseointegration. If indicated, both implants can be used as rigid anchors to facilitate orthodontic tooth movement during the subsequent treatment phase.