CLINICAL FINDINGS
  • Thin gingival biotype
  • Dark discoloration visible through facial gingival tissues
  • Compromised esthetic emergence profiles
  • Failing/restored maxillary central incisors
  • Deficient soft tissue esthetics in anterior maxilla
  • CT scan showed absence/loss of buccal bone plate around both maxillary central incisors.
  • Serial CT images demonstrated compromised facial bone support around teeth #8 and #9.
PP
Dr. Paul Petrungaro
Moderator · IML CaseRounds™
  • Advantages of immediate implant placement and provisionalizationImportance of preserving soft tissue contours and emergence profilesLimitations of titanium implants in thin tissue biotypesBenefits of zirconia implants:
    • Reduced biofilm accumulation
    • Improved soft tissue response
    • Reduced inflammatory response
    • Better esthetics in thin gingival tissues
    • Elimination of gray shine-through effecT
  • Importance of atraumatic extraction and minimally invasive surgeryRole of A-PRF and bioactive grafting materials in regenerationPrevention of peri-implant mucositis and peri-implantitis
Treatment Planning

TOPIC C - ZIRCONIA DENTAL IMPLANTS and IMMEDIATE RESTORATIONLOADING

Patient was unhappy with: Dark discoloration of gingival tissues Poor esthetics around maxillary central incisors Previous failed restorative/endodontic treatments Desire for improved esthetics in the anterior maxilla
PATIENT SUMMARY
AGE / SEX
34
CHIEF COMPLAINT
Patient was unhappy with: Dark discoloration of gingival tissues Poor esthetics around maxillary central incisors Previous failed restorative/endodontic treatments Desire for improved esthetics in the anterior maxilla
ASA CLASS
Class I
SMOKING
Non-smoker
KEY MEDICATIONS
Augmentin® 875 mg prescribed preoperatively one day before surgery
WORKING DIAGNOSIS
DR. PAUL'S TREATMENT PLAN
  1. Preoperative antibiotic protocol with Augmentin
  2. Atraumatic extraction of teeth #8 and #9
  3. Preservation of existing soft tissue architecture
  4. Aggressive socket debridement to remove periodontal ligament and infected tissue
  5. Use of TempStent II surgical guide for ideal implant positioning
  6. Autologous blood draw and preparation of advanced platelet-rich fibrin (A-PRF)
  7. Bone grafting using Osseolive® bioactive graft mixed with A-PRF
  8. Immediate placement of one-piece zirconia implants
  9. Immediate provisional restorations to sculpt and maintain gingival emergence profiles