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ANTERIOR IMPLANT RESTORATIONS – CHALLENGE AND COMPROMISE. A CASE REPORT Figure 5. CM (male, 50): a) 11. implant/abutment supported PFM crown is not accepted anymore; b) new provisional restoration trying to better mimic the anatomy of 12; midline and expected positioning of cervical outline were also evaluated; c) fabrication of a second provisional compromising between symmetry of 11 and 21, emergence profile and implant platform positioning – accepted by patient; e) new shade determination; f, g) final PFM restoration 11; h) patient confirms adequate anatomy and shade match Our crown looked crooked, with an angle from the cervical third to the incisal third and was discarded. The next provisional attempt, a different compromise, with slightly wider cervical aspects, less bulbous distal profile and improved symmetry at the incisal edge level (Fig 5 c, d) was accepted by the patient. A new shade determination was made (Fig 5 e), then the best PFM representation of our provisional was delivered to earn a happy patient again (Fig. 5 f, g, h). Discussion From the perspective of the events we could reiterate that the implant positioning in the esthetic zone is of critical importance, especially for tissue level implants, which, at the time of this treatment were not uncommon. STOMA.EDUJ (2014) 1 (2) Promoting by default the most hygienically favorable design may overlook other aspects which could be regarded at least as important by our patients. In our case a proper lip support in the cervical area, along with better esthetics were certainly more appreciated that an “easy to clean restoration”. Engineering the best emergence profile (case dependent) within the limitations of available bone, implant positioning and design constitutes a fine compromise which may need multiple trial & error stages before reaching an acceptable form. Careful design, fabrication, evaluation, refinement of provisional restorations represents the safest path in order to obtain the best achievable anatomy before ordering a final restoration in the lab. Nowadays, widespread use of bone level implants, immediate placement and 135