1. Patient 2

2. Patient 2
* male
* 35 years
* patient’s request:
- solution for discoloured
central incisor (21)
- (referred patient)
* no medical condition

6. periodontal chart

7. buccal recession 11 and 21
21 internal root resorption, discoloured
diagnosis
slight crowding 21,11
buccally positioned 11,21

8. 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

9. 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)

10. atraumatic extraction

12. atraumatic extraction

13. 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

14. tunnel technique, (split thickness)

15. full thickness flap, dubbel-sling
sub-papilla sutures
Grafting outside the box...

16. buccal hard tissue support

17. ridge preservation

18. connective tissue graft

19. resin-bonded provisional bridge, ovate pontic design

20. three weeks healing

21. eight weeks healingthree weeks healing

22. eight weeks healing initial soft tissue contour

23. osseo-intergration prosthetic
soft tissue management
1st. provisional 2nd. provisional final impression

24. screw retained provisional restoration

25. provisional restoration insertion

26. adding contour for the restorative environment
2nd. provisional final impression

27. Final restorative contour (6 months)

28. communication to laboratory

29. customized CAD/CAM abutment

30. zirconia abutment linered with ceramics

31. etching ceramic and silane application

32. two half deflection cords

33. Before...... ..... After (2 years)

36. 4.5 Year Result

39. cementation 4.5 years