Download - 2 eaed dhr jansen
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Patient 2
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Patient 2
* male
* 35 years
* patient’s request: - solution for discoloured
central incisor (21) - (referred patient)
* no medical condition
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periodontal chart
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buccal recession 11 and 21
21 internal root resorption, discoloured
diagnosis
slight crowding 21,11
buccally positioned 11,21
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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
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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)
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atraumatic extraction
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atraumatic extraction
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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
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tunnel technique, (split thickness)
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full thickness flap, dubbel-sling sub-papilla sutures
Grafting outside the box...
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buccal hard tissue support
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ridge preservation
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connective tissue graft
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resin-bonded provisional bridge, ovate pontic design
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three weeks healing
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eight weeks healingthree weeks healing
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eight weeks healing initial soft tissue contour
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osseo-intergration prosthetic soft tissue management
1st. provisional 2nd. provisional final impression
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screw retained provisional restoration
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provisional restoration insertion
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adding contour for the restorative environment
2nd. provisional final impression
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Final restorative contour (6 months)
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communication to laboratory
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customized CAD/CAM abutment
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zirconia abutment linered with ceramics
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etching ceramic and silane application
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two half deflection cords
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Before...... ..... After (2 years)
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4.5 Year Result
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cementation 4.5 years