Extraction of a malpositioned maxillary anterior implant and simultaneous flapless ridge augmentation: a case report.

Periimplantitis in a malpositioned maxillary anterior implant is one of the most challenging situations in implant dentistry. Since the regenerative treatment can often be unpredictable and have esthetic consequences such as soft tissue recession due to flap raising, extraction is sometimes recommended. In order to place a new implant after extraction, a bone regeneration procedure must be carried out. This implies raising a flap and therefore the risk of further interproximal gingival recession. In the case presented in this article, a hopeless implant at position 11 presented severe periimplantitis and soft tissue recession, which also affected the mesial part of tooth 12. Tooth 21 had a root canal treatment and a crown. After the implant extraction, a minimally invasive simultaneous bone regeneration and soft tissue graft procedure was performed to reconstruct the remaining ridge using xenograft, a collagen membrane, and a connective tissue graft (CTG). Ten months later, in order to improve the ridge profile, an augmentation procedure was carried out using a CTG. Three months later, an implant was placed and immediately loaded. Three months after loading, the right lateral incisor that still presented a mesial gingival recession was slowly extruded by orthodontic treatment until the papilla was symmetrical to the contralateral one. At the end of the orthodontic extrusion, an implant-supported crown was placed at position 11 and a tooth-supported crown delivered in place of tooth 21. A composite restoration was performed on tooth 12. One year later, the soft tissue level was almost symmetrical at incisor level and the periimplant bone level at implant 11 was stable.

Soft and hard tissue management in the treatment of a discolored single tooth in the esthetic zone.

When treating the color of a single tooth in the esthetic zone, it is a complex task to achieve the same visual effect as the rest of the teeth. In addition to the problem of the clinical crown color, if the patient has a thin periodontal biotype it is necessary to manipulate both the hard and soft tissue to achieve a good esthetic result. To change the biotype, a connective tissue graft needs to be performed. The graft must be stabilized exactly where it is needed, and the recipient area modified. The tooth needs to receive an adequate preparation so as to make the restoration thick enough to naturally mask the treated tooth, while also ensuring long-term stability.

Indirect porcelain veneers in periodontally compromised teeth. The hybrid technique: a case report.

The loss of periodontal structure causes an esthetic problem for many patients, especially when the esthetic zone is compromised. Among the various types of solutions is the use of composite resins. While this procedure is not aggressive towards tooth structure, it does require the clinician to have a precise technique, and demands strict longterm maintenance. 1 Another way of treating the compromised teeth is with porcelain veneers. This procedure is especially difficult, however, if carried out on periodontal teeth, as it requires preparation along the roots. 2 The intention of the hybrid technique described in this article is to combine both of these procedures in order to obtain a less aggressive treatment with precise management of the soft tissue and an adequate esthetic outcome. The hybrid technique consists of enlarging the root portion of the teeth with composite resin to obtain a less aggressive tooth preparation, and thereafter placing porcelain veneers.