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Special Issues
July/August 2024
Volume 45, Issue 1
Peer-Reviewed

Managing Anterior Implant Esthetics: Technique for Immediate Placement

A 37-year-old male patient presented with a fractured crown on tooth No. 9, which had been previously treated and restored with a zirconia crown. Clinical examination revealed that the crown had broken at the gingival level, and a ferrule effect could not be achieved without compromising esthetics. Radiographic evaluations confirmed sufficient bone levels for implant placement. The tooth was atraumatically extracted, preserving the buccal bone wall. A 4.2 mm x 12 mm tapered implant with a 3.5 mm platform was placed with an initial torque of 40 Ncm. To facilitate implant success and preserve esthetics, a temporary cylinder was used to maintain the emergence profile, and Duo-Link Universal™ (BISCO, bisco.com) adhesive resin cement was applied to secure the cylinder. The cylinder was relined with composite, and a temporary crown was fabricated. For stabilization, a ribbon was bonded from teeth Nos. 7 and 8 to tooth No. 10 using 37% phosphoric acid, All-Bond Universal® (BISCO), Z-Prime™ Plus (BISCO), and A2 composite. After 4 months, the implant integrated successfully, with the papillae and emergence profile preserved. Digital impressions were taken with an intraoral scanner (Trios®, 3Shape), and a zirconia crown (Katana™ Zirconia, Kuraray) was fabricated and cemented with Thera­Cem® (BISCO). The final restoration achieved excellent esthetics and a functional outcome.

KEY TAKEAWAYS

In anterior implant cases, understanding proper implant placement and
effective management of surrounding tissues is essential to achieving optimal esthetic outcomes.

Use of a temporary cylinder along
with well-polished composite in the extraction site aids in maintaining the emergence profile and preserving the papillae, which are essential for achieving ideal esthetic results.

Employing high-quality materials and ensuring proper bonding techniques are critical to guarantee success throughout the treatment phases, from temporization to the final outcome.

Luis Abrahante, DMD
Private Practice, Alabaster, Alabama; Member, International Congress of Oral Implantologists

Fig 1. Preoperative photograph showing tooth No. 9 fractured at the gingival line with recurrent decay. Tooth No. 10 did not have any restorations.

Figure 1

Fig 2. Preoperative radiograph showing an old defective crown that had fractured on tooth No. 9. The remaining walls on the tooth appeared to be thin with a compromised prognosis.

Figure 2

Fig 3. Final extraction site. Endodontic files were used to remove a piece of root that fractured during the extraction process. Note minimal trauma to the area and preservation of buccal bone and papillae.

Figure 3

Fig 4. A 3D surgical guide was fabricated utilizing a previously taken scan (Trios), planning software (Blue Sky Plan®, Blue Sky Bio), and 3D printing.

Figure 4

Fig 5. An implant (4.2 mm x 12 mm Tapered Pro, BioHorizons®) was placed at least 1 mm below the crestal bone and 5 mm away from the contact of the adjacent teeth.

Figure 5

Fig 6. In this step, a temporary cylinder (BioHorizons) was cut at the gingival level. The socket was filled with DuoLink cement, and the cylinder was relined with composite and polished thoroughly.

Figure 6

Fig 7. A ribbon fiber was utilized. Z-Prime Plus was used on tooth No. 9, and 37% phosphoric acid with All-Bond Universal was used on tooth No. 10.

Figure 7

Fig 8. Temporary crown on No. 9, which the patient wore for 4 months during the healing process of the implant.

Figure 8

Fig 9. The emergence profile, which was obtained using a well-polished composite and temporary cylinder.

Figure 9

Fig 10. A zirconia abutment was used to circumvent potential issues related to show-through of metal color beneath the crown and graying of the gingival tissue.

Figure 10

Fig 11. Because zirconia can be susceptible to contamination from saliva, ZirClean® (BISCO) was used to clean the crown before cementation with TheraCem.

Figure 11

Fig 12. Postoperative radiograph, captured at crown delivery, showcasing a successful implant integration. The radiograph demonstrates appropriate bone levels, affirming the implant’s stability and long-term potential.

Figure 12

Fig 13. Final outcome. Gingival tissues exhibited a healthy appearance, underscoring successful treatment. Adjustments were made to eliminate occlusal contacts during excursive movements.

Figure 13

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