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Patient 2 dhr jansen

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