October 2, 2023

Central Teeth Post To Implant Aesthetic Restoration Conversion

Dr Carmy DIIWC

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Bone sets the tone. This patient is a middle aged male with a destructive grinding habbit as evidenced by the fractured upper anterior incisors which had root canal treatment and crowns. Patient was able to fracture both before turning to DII for help employing implants. Our first surgical treatment appointment we applied the root shield technique in order to preserve the buccal bone and the thick keratinized tissues. Out initial worry was the patient's occlusion and if we would be able to preserve the natural contour of the soft tissues and the papillae.

**Tissue is the issue.** Due to the patient's bite, we covered the implants with cover screws and we did not attach any temporary crowns using stock or temporary abutments but we reverted to old fashioned acrylic device which we relieved from his tissues and checked periodically to make sure his soft tissue architecture had not changed.

**Proths is the BOSS**. After allowing the implants to integrate for 4 months (Fig. 8), we exposed the implants and did a digital impression and designed custom abutments and 2 separate Zirconia crowns, that were glazed and stained to match the patient's own dentition.
Anatomical healing abutments were used while the patient was waiting for the restoration to be finished (after 4 months).

Post-op: 12 month after the final delivery.

As you can see from the final photos, the papillae had been preserved and the soft tissues structure did not suffer any major changes. While designing his occlusion, using Exocad, we made sure that the bite is free and cleared the restoration from any deep centric or protrusive interference for obvious reasons. Pt's was brought back at the 6 months mark for another photo and x-ray where no notable changes to he bone or the soft tissues are noted. One would be hard pressed to pick out the restoration as fake since the seamless blending of the tissues and the shade helped bring this case home.
**It is true what they say, "Bone sets the tone. Tissue is the issue, BUT proths is the BOSS."**

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SUBMITTED BY

Dr Carmy Michael

DDS

A graduate of University of Western Ontario Schulich School of Medicine & Dentistry with a degree of Doctor of Dental Surgery 2004 with a 6 months residency.

Also a graduate of Cairo University, School of Dentistry 1993 with a 1 year residency. Extensive training in the field of Dental Implantology and Digital Work Flow in Dentistry, A journey that started over 10 years ago and is still ongoing. Certified in Oral Sedation through DOCS and IV Conscious Sedation.

Active member of the Academy of Osseointegration (AO)

A Fellow of the Global Dental Implant Academy-CA (GDIA)
A member of the International Congress of Implantologists (ICOI)
Extensive training in Full Arch Restoration (Nobel and GDIA)
A Certified Provider for Institute for Advanced Laser Dentistry (LANAP & LAPIP)
Specialized training on 3 Shape & Exocad
Fellowship from Dental Implant Association (DIA)
Member with good standing in the CDA, MDA, ADA & OCDS
Digital Work flow for Implant Restoration.

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