Interdisciplinary Treatment of Severe Bone Deficiency in the Aesthetic Area Using Implant Supported Restoration with Pink-colored Porcelain
Author: Tsachouridou Ioanna
Publisher:
Published: 2017
Total Pages:
ISBN-13:
DOWNLOAD EBOOKIntroductionReplacing missing teeth in the aesthetic zone with dental implants remains a challenge. In order to maintain or restore bone and soft tissue, many procedures have been recommended, varying from the immediate placement with minimal tissue grafts to an extensive treatment procedure with bone grafting, possibly in combination with connective tissue grafts. Orthodontic extrusion is another treatment option, that enables the regeneration of bone and soft tissue both in horizontal and vertical dimension. Moreover, the use of pink-colored ceramics can offer an effective method of providing an aesthetic outcome when the aforementioned techniques are not applied or have failed.AimThe purpose of this presentation is the description of a complex case where an interdisciplinary treatment plan was applied in order to restore severe alveolar bone loss that resulted in tooth loss in the aesthetic area. Materials and MethodsA 23-year-old female patient, which was referred to the Department of Periodontology, presented with a severe osseous defect in teeth #22, #23 due to previous orthodontic treatment. In particular, #23 was impacted and after surgical exposure and orthodontic traction, bone surrounding #22 and #23 was destroyed and root resorption was noticed. Both teeth had third degree mobility and extensive attachment loss was recorded. ResultsAfter initial impressions and diagnostic wax up, the treatment plan was made, and different options were presented to the patient. The definitive treatment plan included the extraction of teeth #22, #23 and placement of two implants. Because of the extensive bone deficiency both in vertical and horizontal level, orthodontic extrusion of the teeth was applied . After the orthodontic extraction, extensive Guided Bone Regeneration-GBR was applied using double layer technique (allograft, xenograft, collagen membrane and pins) and a resin-bonded metal-acrylic prosthesis was placed as a temporary restoration. Six months later, two implants (straumann) were placed and xenograft was also applied covered with Mucograft for tissue gain. After six months, second stage surgery was conducted and connective tissue graft was placed in order to augment soft tissue volume. Three months later, when soft tissue healing was completed, the steps for the definitive procedure were followed. Two multi-unit (straumann) abutments were used, with 17o angle to restore implant angulations, and a metal-ceramic Fixed Partial Denture-FPD was fabricated, that was screw-retained to the abutments. Pink-colored porcelain was used aiming to replace the tissue loss in vertical dimension. The patient was fully satisfied with both the aesthetic and functional result.DiscussionImplant placement and restoration in the aesthetic zone is highly demanding in terms of aesthetic outcome and patients' satisfaction, especially in cases with extreme deficiencies in soft tissue and bone. In such cases, careful treatment planning and collaboration among different specialties is mandatory, while the use of pink-colored porcelain can provide an aesthetic outcome without the application of extensive bone grafting procedures.
