Patient 2
Patient 2
* male
* 35 years
* patient’s request:
- solution for discoloured
central incisor (21)
- (referred patient)
* no...
periodontal chart
buccal recession 11 and 21
21 internal root resorption, discoloured
diagnosis
slight crowding 21,11
buccally positioned 11...
how could we satisfy the patient’s aesthetic
wishes?
is it possible to improve soft tissue levels 11
and 21 (more incisall...
extraction 21
if possible immediate implant
placement and ridge preservation
adjust soft tissue levels 11 and
21with conne...
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 imp...
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
Patient 2  dhr jansen
Patient 2  dhr jansen
Patient 2  dhr jansen
Patient 2  dhr jansen
Patient 2  dhr jansen
Patient 2  dhr jansen
Patient 2  dhr jansen
Patient 2  dhr jansen
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Patient 2 dhr jansen

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Patient 2 dhr jansen

  1. 1. Patient 2
  2. 2. Patient 2 * male * 35 years * patient’s request: - solution for discoloured central incisor (21) - (referred patient) * no medical condition
  3. 3. periodontal chart
  4. 4. buccal recession 11 and 21 21 internal root resorption, discoloured diagnosis slight crowding 21,11 buccally positioned 11,21
  5. 5. 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
  6. 6. 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)
  7. 7. atraumatic extraction
  8. 8. atraumatic extraction
  9. 9. 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
  10. 10. tunnel technique, (split thickness)
  11. 11. full thickness flap, dubbel-sling sub-papilla sutures Grafting outside the box...
  12. 12. buccal hard tissue support
  13. 13. ridge preservation
  14. 14. connective tissue graft
  15. 15. resin-bonded provisional bridge, ovate pontic design
  16. 16. three weeks healing
  17. 17. eight weeks healingthree weeks healing
  18. 18. eight weeks healing initial soft tissue contour
  19. 19. osseo-intergration prosthetic soft tissue management 1st. provisional 2nd. provisional final impression
  20. 20. screw retained provisional restoration
  21. 21. provisional restoration insertion
  22. 22. adding contour for the restorative environment 2nd. provisional final impression
  23. 23. Final restorative contour (6 months)
  24. 24. communication to laboratory
  25. 25. customized CAD/CAM abutment
  26. 26. zirconia abutment linered with ceramics
  27. 27. etching ceramic and silane application
  28. 28. two half deflection cords
  29. 29. Before...... ..... After (2 years)
  30. 30. 4.5 Year Result
  31. 31. cementation 4.5 years
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