Page 46 - CEREC Q3 | 2014

44 | CERECDOCTORS.COM | QUARTER 3 | 2014
surgical and restorative procedures to
achieve an improved esthetic outcome
due to correctly proportioned and
contoured maxillary anterior teeth
within the patient’s smile. It is there-
fore important to not only focus on the
specific implant site but rather on the
patient’s overall smile when performing
implant therapy in the esthetic zone.
Acknowledgements: I would like to thank
Dr. Mike Rogers (Arlington, Texas) for
the restorative treatment provided for
the patient in this case example.
For questions and more information,
Dr. Boltchi can be reached at
fboltchi@tx.rr.com.
||| BOLTCHI
An alternative
in these types of
cases is the early
implant place-
ment approach.
The primary goal
of this technique
is to allow for six
to eight weeks of
soft-tissue healing
after the extrac-
tion to achieve a completely healed
soft-tissue covering in the future implant
site. The combinationof the early implant
placement technique and guided implant
surgery as outlined above eliminates the
two main reasons for the development
of a facial gingival recession, the lack of
a stable facial bone wall to support the
facial soft tissues, and the facial malposi-
tion of the implant. The precise transfer
of the preoperative digital treatment plan
to the surgical field via guided implant
surgery ensures that the implant is posi-
tioned in the correct restorative position
and the buccal contour augmentation
and layered bone grafting technique
ensures the establishment of a facial bone
wall of sufficient height and thickness to
serve as support for long-term, stable
peri-implant soft-tissue contours.
A series of recent studies have shown
that early implant placement has a
reduced risk for gingival recession when
compared with immediate implants,
thereby achieving a high degree of
predictability for long-termstable esthetic
outcomes. However, this approach also
requiresmultiple surgical procedures, one
of which is a major flap procedure with
the associated postoperative morbidity, a
possible increased risk of loss of papillary
height, and an increased risk of exposure
of adjacent restorative crownmargins.
The other interesting aspect of this
case report is the facially generated
treatment plan incorporating additional
Fig. 35: Postoperative smile view
Fig. 36: Preoperative full-facial view
Fig. 37: Postoperative full-facial view
Fig. 38: Postoperative radiograph of
final implant restoration
Fig. 39: 11 months’ postoperative
CBCT views implant #8
36
38 39
37 35