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
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