After three days, two 4.1mm GingiHue® Posts (with Emergence Profile diameters of 5mm) were placed. GingiHue Posts are manufactured with gold colored titanium nitride coatings to prevent a gray cast showing through at the soft tissue margin. These were prepared by the dental technician on the master cast. The prepared abutments were inserted into the internal interface of the implants with an audible and tactile “click” to ensure complete seating. Following radiographic verification, the abutment screws were torqued to 20Ncm. Two acrylic resin provisional crowns were fabricated without occlusal contacts (based on an immediate non-occlusal loading protocol) and secured to the abutments with temporary cement (Figures 5 and 6).
The patient was given instructions to perform twice daily gentle brushing with a toothpaste containing chlorhexidine and to avoid any functional loading on the crowns for eight weeks.
Following an uneventful two-month healing period, osseointegration was confirmed and two splinted metal-ceramic crowns were placed. The definitive crowns were constructed on duplicate abutments with a soft tissue transfer impression through the use of resin transfer copings. The pre-programmed buccal margin of the abutments, 1mm coronal to the implant platform, was 2mm below the facial gingival margin. The definitive crowns were splinted, at the request of the patient, who had the provisional crowns splinted and felt greater confidence and security (Figure 7). The prognosis for maintenance of the interdental papillae was excellent.
CLINICAL OVERVIEW
Atraumatic, flapless removal of fractured maxillary central incisors and debridement of the extraction sockets was performed to decrease surgical trauma and increase the potential to preserve the buccal plate of bone. The treating clinician’s decision to place two large diameter Certain® PREVAIL® (internally interfaced) Implants was made to facilitate full engagement of the bony walls of the extraction sockets, completely obturate the occlusal aspect of the extraction sites, preserve crestal bone, as well as maintain the interdental papillae in this highly aesthetic smile zone. Twelve months post-implant placement (ten months post-occlusal loading), there was radiographic evidence of successful osseointegration and crestal bone preservation was observed (Figure 8).
