Dental Asia Sep/Oct 2019

Clinical Feature DENTAL ASIA SEPTEMBER / OCTOBER 2019 38 P rosthetic restoration of the anterior teeth represents a major challenge, as much from a surgical point of view as from a prosthetic point of view. The visible nature of these restorations imposes high aesthetic results and requires the reconstruction of the soft and hard tissues that will surround the future prostheses. The prosthetic design plan The establishment of a prosthetic design plan at the beginning of treatment is critical, firstly for the harmonious integration of the dental arrangement with the patient’s lips and face, and secondly to accommodate the design plan with the bone and gingival anatomy of the patient. The design plan should take into consideration both functional and aesthetic components. In the clinical situation presented here, with the teeth being in place, a prosthetic proposition cannot be clinically validated. The accurate recording and communication of aesthetic and functional components are of utmost importance to enable the dental technician to work under the best conditions possible. The aesthetic components will include the taking of photos (intraoral, the smile, the face), and the recording of aesthetic reference planes by the Ditramax system. Anterior Implant Restoration: The Extractions-Implantations Continuum By Patrice Margossian , Manon Vuillemin , Cécile Touitou , Gilles Philip and Stevie Pasquier The dental technician is then provided with a horizontal line (interpupillary line) and a vertical line (facial midline) traced on a maxillary cast (Fig. 1). The objective of this system is to give the dental technician the impression of working face to face with Fig. 1: Recording of the aesthetic components by the Ditramax system Fig. 2: Initial radiological situation Figs. 4: Alveoli management after extraction Fig. 3: Initial intraoral situation observation signifies the non-conservation of the central and lateral incisors. The therapeutic request includes the patient’s wish for diastema closure treatment. The proposed treatment for this option is a supra-structure implant bridge on 12 and 22 with the placement of two implants at the lateral incisor sites. A dental impression of the four maxillary incisors is made with the patient. The functional components are provided by the articulator. The assembly is carried out using a facial arch recording (Artex, Amann Girrbach, Arseus-lab). The patient presents considerable bone loss around the maxillary central incisors, as well as on the mesial side of the lateral incisors (Fig. 2). The central incisors are very mobile and enveloped in an inflammatory mucopurulent discharge (Fig. 3). This a cast to measure the aesthetic impact of the diastema closure with the widening of the four teeth. This prosthetic design plan will serve as a guide for all the following steps, both surgically and prosthetically, in a “prosthetically guided regeneration” concept. Regeneration and temporisation A smoking cessation plan is imposed on the patient and initial periodontal therapy is put in place. The extraction of the incisors imposes alveolar (socket preservation) management to be put in place to limit bone resorption. Both central incisor sites are filled with slow resorption biomaterial (BioOss Geistlich) as they are located at the site of the bridge abutment teeth. The lateral incisor sites, however, are filled with an allogenic graft (BioBank) to enable full and rapid bone integration, as this is the implant area. The four alveoli are filled with four circular epithelial connective tissue grafts taken from the palatal zone, in order to preserve tissue volume and protect the grafts Fig. 3a Fig. 3b