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Gabriele Caruso

Cagliari, Italy

Clinical case description:

A male patient 18 years and 7 months y.o. lost a central left incisor (tooth 21) due to dislocation after a motorcycle accident. He came to our practice in order to replace the missing tooth with an implant. Both the dental and medical anamnesis were negative, he did not have a periodontitis and he is not a smoker. Treatment sequence:

• Patient’s data collection, signed informed consent.

• Periapical radiograph of the site 21, using X-ray ring to obtain parallel technique.

• Surgery: implant (4,8 x 13 mm) positioning in site 21 and simultaneous little GBR technique (Geistlich Bio-Oss® and Geistlich Bio-Gide®, Geistlich Pharma AG, Switzerland).

• Delivery of the provisional crown, made with CAD/CAM technique.

• Delivery of the definitive crown, made with CAD/CAM technique.

• Periapical radiograph of the left central incisor, using X-ray ring to obtain parallel technique, at 30 months of loading.

In this clinical case we were able to achieve the entire interproximal papilla in both sites, mesial and distal.

We supposed that the emergence profiles of provisional and definitive crowns were able to support and keep the gingiva in a new position, up to 30 months of loading.

The aesthetic of the periimplant gingiva can be enhanced through modification of the edge, shape and depth and the prosthetic restoration's emergence profile. In order to put this technique in practice, it is necessary to utilize a conical transmucosal implant segment which allows modifications on prosthetic restoration. These modifications imply clinical meaningful effects. Nonetheless, further studies are required to build a link between the prosthetic emergence profile, requirements of soft tissue and periimplant gingiva ‘s adaptation.

Further studies should also establish a clinical protocol about emergence profile’s guidelines.

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<p>Male patient 18 years and 7 months y.o. missing a central left incisor (tooth 21). Pictures with lip retractors 4 months after the accident.</p>

Male patient 18 years and 7 months y.o. missing a central left incisor (tooth 21). Pictures with lip retractors 4 months after the accident.

<p>Implant (4,8 x 13 mm) positioning in site 21 and simultaneous little GBR technique (Geistlich Bio-Oss<sup>®</sup> and Geistlich Bio-Gide<sup>®</sup>, Geistlich Pharma AG, Switzerland).</p>

Implant (4,8 x 13 mm) positioning in site 21 and simultaneous little GBR technique (Geistlich Bio-Oss® and Geistlich Bio-Gide®, Geistlich Pharma AG, Switzerland).

<p>Delivery of the provisional crown, made with CAD/CAM technique: we are missing mesial and distal interproximal papillae.</p>

Delivery of the provisional crown, made with CAD/CAM technique: we are missing mesial and distal interproximal papillae.

<p>Definitive crown, made with CAD/CAM technique, control at 30 months of loading: we were able to achieve the entire interproximal papilla in both sites, mesial and distal.</p>

Definitive crown, made with CAD/CAM technique, control at 30 months of loading: we were able to achieve the entire interproximal papilla in both sites, mesial and distal.

Pre-surgery


					<p>Male patient 18 years and 7 months y.o. missing a central left incisor (tooth 21). Pictures with lip retractors 4 months after the accident.</p>

Surgery


					<p>Implant (4,8 x 13 mm) positioning in site 21 and simultaneous little GBR technique (Geistlich Bio-Oss<sup>®</sup> and Geistlich Bio-Gide<sup>®</sup>, Geistlich Pharma AG, Switzerland).</p>

Outcome


					<p>Delivery of the provisional crown, made with CAD/CAM technique: we are missing mesial and distal interproximal papillae.</p>

Follow-up after at least 6 months


					<p>Definitive crown, made with CAD/CAM technique, control at 30 months of loading: we were able to achieve the entire interproximal papilla in both sites, mesial and distal.</p>