Clinical Indication: Papilla Preservation Adjacent To Teeth

Clinical Treatment By Dr. Roberto Cocchetto (ITALY)

INITIAL PATIENT PRESENTATION
A non-smoking 45-year-old female patient in good health presented with a failing, maxillary right first bicuspid. The tooth had previously been treated with endodontic therapy and was restored with a PFM crown. There was a fistula present with mesial furcation involvement. The combined lesions and the presence of adjacent clinically acceptable PFM crowns eliminated the possibility of performing periodontal resective surgery, without compromising the adjacent teeth and overall aesthetics. The prognosis for retreating the tooth endodontically was poor. The patient desired a fixed restoration to replace her failed natural tooth. A treatment plan was developed that avoided compromising the adjacent dentition.

DIAGNOSIS

• Nonrestorable, failed, maxillary right first bicuspid (combined periodontal/ endodontic lesion)
• Healthy, stable soft-tissue
• Inadequate bone volume for placement of a dental implant (grafting would be required)

TREATMENT PLAN

• Atraumatic removal of the maxillary right first bicuspid debridement of the extraction socket, placement of synthetic bone graft material and an OSSIX ™ Membrane
• Osseous healing (four months)
• With a single-stage protocol, flapless placement of a 4mm x 13mm Certain® PREVAIL® (internally interfaced) Implant, placement of a 4mm x 5mm Encode® Healing Abutment and impression of the Encode Healing Abutment
• Osseointegration (12 weeks)
• Placement of the definitive Encode Abutment and provisional crown
• Placement of the definitive PFM crown onto the Encode Abutment three months following abutment connection

SURGICAL TREATMENT

The hopeless maxillary right first bicuspid (Figure 1) was carefully extracted in a flapless procedure. Following socket debridement, synthetic bone graft material was placed into the extraction socket. An OSSIX Membrane was placed and a soft tissue graft was used to cover the membrane (Figures 2 and 3).

After four months of healing, (Figure 4) a 4mm platform diameter x 13mm length Certain PREVAIL Implant was placed in a single-stage protocol. A full thickness flap was not made in the soft tissue to facilitate implant placement, but rather, the clinician used a 5mm tissue punch to protect the integrity of the soft-tissue margins on the adjacent PFM crowns and expose the implant site. The specific implant diameter and length was selected based on the size and shape of tooth to be replaced and the adjacent natural dentition.

A 4mm tall transmucosal Encode® Healing Abutment was placed into the internal interface of the implant. An intraoral radiograph was taken for verification (Figure 5) and an impression was made of the Encode Healing Abutment. An alginate impression was also made of the opposing arch. The patient was discharged with antibiotic and anti-inflammatory prescriptions. The impressions, interocclusal registration and shade selection were sent to the dental laboratory. In the dental laboratory the master cast was articulated and sent to 3i for fabrication of an Encode Abutment for a patient specific abutment.