The Journal of Indian Prosthodontic Society

CLINICAL REPORT
Year
: 2008  |  Volume : 8  |  Issue : 4  |  Page : 213--215

Replacement of an upper central incisor with an implant supported crown: A case report to achieve acceptable esthetics for a malpositioned implant


Nur Hersek1, Hasan Onder Gumus2, Ferda Tasar3, Mustafa Saysel3,  
1 Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
2 Department of Prosthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
3 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University, Ankara, Turkey

Correspondence Address:
Hasan Onder Gumus
Department of Prosthodontics, Faculty of Dentistry, Erciyes University, Kayseri
Turkey

Abstract

Esthetics in implantology is a topic currently attracting a lot of attention from dental implantologists all over the world. It includes both white and red esthetics with much greater importance given to red esthetics. An ideal implant position in all 3 dimensions is required. These mesiodistal, apicocoronal, and orofacial dimensions are well described, defining DQcomfortDQ and DQdangerDQ zones for proper implant position in the anterior maxilla. Adequate bone base is usually a prerequisite for functionally and esthetically optimal reconstruction of the soft tissue architecture around a dental implant. When implants are malpositioned axially, prefabricated angled abutments or custom abutments may be used for restoration to acceptable function and comfort.



How to cite this article:
Hersek N, Gumus HO, Tasar F, Saysel M. Replacement of an upper central incisor with an implant supported crown: A case report to achieve acceptable esthetics for a malpositioned implant.J Indian Prosthodont Soc 2008;8:213-215


How to cite this URL:
Hersek N, Gumus HO, Tasar F, Saysel M. Replacement of an upper central incisor with an implant supported crown: A case report to achieve acceptable esthetics for a malpositioned implant. J Indian Prosthodont Soc [serial online] 2008 [cited 2021 Apr 23 ];8:213-215
Available from: https://www.j-ips.org/text.asp?2008/8/4/213/49185


Full Text

Esthetics in implantology is a topic currently attracting a lot of attention from dental implantologists all over the world. It includes both white and red esthetics with much greater importance given to red esthetics. [1],[2] An ideal implant position in all 3 dimensions is required. [3],[4] These mesiodistal, apicocoronal, and orofacial dimensions are well described, defining "comfort" and "danger" zones for proper implant position in the anterior maxilla. [5]

An adequate bone base is usually a prerequisite for functionally and esthetically optimal reconstruction of the soft tissue architecture around a dental implant. [6]

The standard parameters for achieving esthetic implant prosthesis result in one that is in harmony with the perioral facial structures of the patient. The esthetic peri-implant tissues, in their health, height, volume, color, and contours, must be in harmony with the healthy surrounding dentition. The restoration should imitate the natural appearance of the missing dental unit(s) in color, form, texture, size, and optical properties. [7]

When implants are malpositioned axially, prefabricated angled abutments or custom abutments may be used for restoration to acceptable function and comfort.

 Case Report



A 21-year-old female patient's upper left central incisor had to be extracted because of apical lesion a few years ago. The patient was wearing a removable space holder [Figure 1]. Patient history, examination, and radiographic evaluation confirmed that the patient's missing maxillary left central incisor labial region had a bony defect. Using surgical techniques, the facial bone wall was augmented using bone substitutes to create an adequate ridge. After 5 months 3.8x11 implant fixture (Friadent-Xive Friadent GmbH Manheim Germany) was inserted., As the bone quality and density of the grafted area was poor and due to facial bone deficiency, ideal positioning of the implant was not possible during surgery. The implant was observed to be significantly malpositioned axially. The implant was restored at 6 months after second stage surgery. Healing abutment was inserted (Friadent gingival former) to reveal healthy tissue. An implant-level impression with Friadent transfer coping [Figure 2], using the closed custom tray technique, was completed with polyether impression material (Impregum Penta Soft 3M Espe AG Seefeld, Germany). Implant analogs were placed, a gingival replica was completed in silicone material (Gingitech; Ivoclar Vivadent AG, Schaan, Liechtenstein), and the definitive cast was poured in type V die stone. During abutment selection, even angled abutments could not correct the malposition. Treatment options for restoring the dentition to optimal function and esthetics were presented to the patient.

Gold custom abutment fabrication was planned using Friadent-AuroBase [Figure 3]. The Friadent-AuroBase consists of a gold alloy cast to abutment and waxing sleeve. It can be used to fabricate a one-piece restoration incorporating the abutment. The restoration was labially screw-retained to the implant. Prior to placement of the abutments and restorations, healing abutments were removed. The gold custom abutment was prepared and connected to the implant with a titanium screw tightened. The abutment was adjusted and sent back to the technician and ceramic restoration was finished. Metal reinforced ceramic crown was fabricated, coping was tried and margin integrity, occlusal relationship, and esthetics were verified [Figure 4]. The crown was finished, the screw-access opening was filled with cotton packing, and the restorations were cemented using provisional cement designed for cementation of implant restorations. The patient has been followed regularly for routine hygiene and evaluation of long-term success of the restorations. She has continued to report excellent comfort and function and is pleased with the esthetic outcome.

 Conclusions



Horizontal and vertical bone deficiencies result in malpositioning of dental implants. The maximum disangulation in relation to the long axis of the implant is recommended not to exceed 30; severe malposition of the implant in the esthetic zone may be solved by the prosthodontist to some degree.

References

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