Patient 2

Patient 2

* male

* 35 years

* patient’s request: - solution for discoloured

central incisor (21) - (referred patient)

* no medical condition

periodontal chart

buccal recession 11 and 21

21 internal root resorption, discoloured

diagnosis

slight crowding 21,11

buccally positioned 11,21

how could we satisfy the patient’s aesthetic wishes?

is it possible to improve soft tissue levels 11 and 21 (more incisally)

Is the patient willing to go through orthodontic treatment, periodontal surgery and to manage teeth restoratively?

can we restore this patient predictably with long-term strategy?

primary concerns

Can the hard an soft tissue volume be maintained/ improved/stabilised after extraction 21

how do we manage the space problem

extraction 21

if possible immediate implant placement and ridge preservation

adjust soft tissue levels 11 and 21with connective soft tissue graft

restore 21 with provisional restoration (resin bonded bridge) for 2 months

treatment plan

restore 21 with ceramic restoration

restore 21 with provisional restoration (screw retained) for 6 months

soft tissue maturation and management phase (6months)

restriction of treatment: only 21 (soft tissue 11)

atraumatic extraction

atraumatic extraction

T r e a t m e n t

O u t c o m e

resin-bonded bridge screw retained provisional

1st. provisional 2nd. provisional final impression

tunnel technique, (split thickness)

full thickness flap, dubbel-sling sub-papilla sutures

Grafting outside the box...

buccal hard tissue support

ridge preservation

connective tissue graft

resin-bonded provisional bridge, ovate pontic design

three weeks healing

eight weeks healingthree weeks healing

eight weeks healing initial soft tissue contour

osseo-intergration prosthetic soft tissue management

1st. provisional 2nd. provisional final impression

screw retained provisional restoration

provisional restoration insertion

adding contour for the restorative environment

2nd. provisional final impression

Final restorative contour (6 months)

communication to laboratory

customized CAD/CAM abutment

zirconia abutment linered with ceramics

etching ceramic and silane application

two half deflection cords

Before...... ..... After (2 years)

4.5 Year Result

cementation 4.5 years