This document describes the treatment plan for a 35-year-old male patient with discoloration of his central incisor tooth. The treatment plan involves extracting the discolored tooth, immediately placing an implant, and performing a soft tissue graft to improve gum levels. A provisional restoration will be placed for 2 months, followed by a screw-retained provisional for 6 months to allow for soft tissue maturation. Finally, the tooth will be restored with a ceramic restoration. The goal is to satisfy the patient's aesthetic needs with a predictable long-term restoration.

1. Patient 2

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

6. periodontal chart

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

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?
how do we manage the space problem
Can the hard an soft tissue volume be maintained/
improved/stabilised after extraction 21
can we restore this patient predictably with
long-term strategy?
primary concerns

9. restriction of treatment: only 21 (soft tissue 11)
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
restore 21 with provisional
restoration (screw retained) for
6 months
soft tissue maturation and
management phase (6months)
restore 21 with ceramic
restoration
treatment plan

10. atraumatic extraction

12. atraumatic extraction

13. T
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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. three weeks healing eight 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. 2nd. provisional final impression
adding contour for the restorative environment

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