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Management of interproximal soft

tissue with a resin-bonded prosthesis

after immediate implant placement: A
clinical report
Erdem Ozdemir, DDS, PhD,a Wei-Shao Lin, DDS,b and
Selim Erkut, DDS, PhDc
School of Dentistry, Baskent University, Ankara, Turkey;
University of Louisville, School of Dentistry, Louisville, Ky
This report describes immediate implant placement after the extraction of a vertically fractured tooth. During the
healing phase, a resin-bonded prosthesis was inserted as a provisional restoration. After the creation of the optimal
emergence profile and papillae with the provisional restoration, the definitive metal ceramic crown was fabricated. (J
Prosthet Dent 2012;107:7-10)

The teeth most affected by trauma proach is contraindicated if primary in thinning the epithelium and create
are the maxillary incisors because of stability cannot be achieved because new soft tissue contours.21
their protruded position.1 When max- of surgical trauma, inadequate bone This article describes a technique
illary incisors are lost, conventional quality or quantity, or unfavorable using an RBP as an immediate pros-
fixed, resin-bonded, partial-remov- occlusion.11-13 Different insertion pre- thesis during osseointegration in the
able, and implant-supported pros- loads have been suggested to obtain anterior region. The pressure applied
theses (immediate implant placement primary stability and immediate load- by the ovate pontic design of the RBP
in the extraction socket or delayed ing of implants.3,14-16 Although several achieves interdental papilla forma-
implant placement at the healed site) factors can affect the primary stabil- tion and maintains the soft tissue
are treatment options.2 ity, such as implant design, diameter, contours.
Clinical studies have demonstrat- length, and surface texture, Wang et
ed similarly favorable treatment out- al17 advocated a minimum torque CLINICAL REPORT
comes for immediate implant place- of 32 Ncm to 35 Ncm for immedi-
ment in the extraction socket and ate loading of single implants. When A 28-year-old man presented to
implant placement in the healed site immediate implant placement/im- the Prosthodontics department at
in terms of implant survival, marginal mediate loading cannot be achieved the University of Baskent with acute
bone resorption, soft tissue level, and in the esthetic region, other types of symptoms related to the right central
the incidence of complications.3-9 Key provisional prostheses are needed. A maxillary incisor. The tooth present-
factors associated with successful im- fixed prosthesis used as a provisional ed with failed endodontic treatment
mediate implant treatment include restoration can increase patient satis- and the radiographic examination
atraumatic root extraction and facial faction more than a removable one. revealed a fractured root. No pathol-
bone preservation.10 With simulta- A resin-bonded prosthesis (RBP) is an ogy of the bone and adjacent teeth
neous tooth extraction, immediate alternative treatment option since it was noted (Fig. 1). Treatment options
implant placement and immediate provides the comfort of a fixed pros- were presented to the patient, includ-
placement of a provisional restora- thesis and requires only minimal in- ing a conventional fixed prosthesis
tion, improved esthetics and patient tervention.18 It has been reported that and an implant-supported single
comfort with a fixed prosthesis can be soft tissue contours can be improved crown. The conventional fixed pros-
provided. This approach can decrease by applying well-controlled pressure thesis option was declined by the pa-
the treatment time and the number of with a convex and highly polished tient because of the need to prepare
surgeries for patients, therefore, po- pontic surface.19,20 Applying pressure the adjacent teeth. The implant-sup-
tentially increasing the acceptance of to the soft tissue and maintenance ported single crown option was ac-
dental implant treatments. This ap- of oral hygiene and plaque can result cepted by the patient, and informed

Clinical Doctor, Department of Prosthodontics, Faculty of Dentistry, Baskent University.
Assistant Professor, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville.
Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Baskent University.
Ozdemir et al
8 Volume 107 Issue 1
consent was obtained. A 4 mm 13
mm dental implant (Astra Tech AB,
Mlndal, Sweden) was placed imme-
diately after the atraumatic extraction
of the root of the right maxillary cen-
tral incisor. Because adequate primary
stability for immediate loading was
not achieved, a 2-stage surgical pro-
tocol was used. The implant was sub-
merged and allowed to integrate for 6
months. After the implant surgery, a
maxillary impression for the provision-
al RBP was made with condensation
silicone (Speedex; Coltne/Whale-
dentAG,Altsttten, Switzerland) and
the impression was poured with type
IV dental stone (Amberok; Anadolu
Dental Products, Istanbul, Turkey).
An irreversible hydrocolloid impres-
sion (Blueprint Cremix; Dentsply De-
Trey, GmbH, Konstanz, Germany) was
1 Periapical radiograph indicated root fracture of
right maxillary central incisor. made of the opposing mandibular
dentition. The casts were articulated
in a semiadjustable articulator (Pro-
tar Evo 2; Kavo, Biberbach, Germany)
with facebow transfer and an interoc-
clusal centric relation record.
The pattern for the retainers and
pontic of the provisional RBP was fab-
ricated from sculpturing wax (Tho-
wax; Yeti Dental Products GmbH,
Engen, Germany). The metal frame-
work was fabricated with Ni-Cr alloy
(Wiron 99; Bego Dental, Bremen,
Germany) and adjusted intraorally.
An ovate pontic was created with low-
2 RBP was cemented with resin adhesive cement in place fusing feldspathic porcelain (Omega
after immediate implant placement. 900; VITA Zahnfabrik, Bad Sckingen,
Germany) according to the manufac-
turers instructions. The ovate pon-
tic, with its convex shape, contacts
a large area of soft tissue and places
pressure on that tissue. The RBP was
then adapted to the edentulous ridge
and cemented with adhesive resin ce-
ment (Panavia F 2.0; Kuraray, Tokyo,
Japan) according to the manufactur-
ers instructions (Fig. 2). The RBP was
inserted 3 days after surgery and the
patient was not provided with a provi-
sional restoration during this period.
A panoramic radiograph was made to
3 Panoramic radiograph of dental implant and RBP. establish baseline information (Fig.
3). Oral hygiene instructions were
given to the patient, which included
The Journal of Prosthetic Dentistry Ozdemir et al
January 2012 9

4 RBP removed at 3-month appointment. Intaglio surface 5 Healed interproximal soft tissue was mature and demon-
of pontic adjusted to achieve proper soft tissue contour. strated adequate volume at 6-month recall appointment.

6 Definitive crown in place.

tooth brushing and daily flossing. silicone (Express; 3M ESPE, St Paul, DISCUSSION
With the accessibility of the convex Minn.) with an open tray technique.
pontic surface and the good oral hy- The RBP was recemented after the im- An implant was placed in a fresh
giene maintained by the patient, no pression procedure. An elastomeric extraction site and the loading of the
plaque was observed during the re- material for gingival reproduction implant was delayed until osseoin-
call examinations. At the 3-month (Gi-Mask, Coltne/Whaledent) was tegration was achieved. During the
recall, the RBP was removed (Fig. 4), injected around the impression cop- healing period, several provisional
and the intaglio surface of the pontic ing. A prefabricated abutment (Ti De- prosthesis options were available to
adjusted to achieve proper soft tis- sign 3.5/4.0; Astra Tech AB, Mlndal, provide an esthetic solution. Boff et
sue contour. Rubber polishing discs Sweden) was selected and prepared. al2 proposed a provisional removable
(OptraFine; Ivoclar, Schaan, Liechten- The metal coping for the definitive prosthesis for the 6-month healing
stein) were used to polish the ceramic restoration was fabricated with base period. As opposed to a removable
surface after adjustment. The RBP metal alloy (Wiron 99, composition prosthesis, there are several advan-
was recemented with adhesive resin %: Ni: 65, Cr: 22.5, Mo: 9.5, Si: 1, tages of the RBP used in this report,
cement (Panavia F 2.0, Kuraray). At Nb: 1, Fe: 0.5, Ce: 0.5, C: max.0.02; including the fact that it is minimally
the 6-month recall no complications Bego Dental).22 Low fusing porce- invasive, has higher patient satisfac-
were noted. The RBP was removed lain (Omega 900; VITA Zahnfabrik) tion, achieves an immediate esthetic
and the interproximal soft tissue had was applied to the metal coping. The result, and creates interdental papil-
healed and matured with adequate definitive crown was evaluated intra- lae by applying pressure. In this situ-
volume (Fig. 5). The implant was ac- orally and the proper occlusion was ation, the esthetic result of the soft
cessed with a mucosal punch flapless achieved. The definitive crown was tissue was improved by applying well-
technique. A maxillary implant level cemented with glass ionomer cement controlled pressure with the pontic.
impression was made with addition (Ketac Cem; 3M ESPE) (Fig. 6). Proper hygiene access was achieved
Ozdemir et al
10 Volume 107 Issue 1
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The Journal of Prosthetic Dentistry.

The Journal of Prosthetic Dentistry Ozdemir et al