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Dr. Tidu Mankoo

Restoration of a missing lateral incisor

Dr. Tidu Mankoo

Dental technicians Luc & Patrick Rutten

Patient with congenitally missing right and peg-shaped left lateral incisor. Orthodontic treatment was carried out to align the teeth and create the correct space for restoration of both lateral incisors. The maxillary left incisor was restored with a lithium disilicate veneer followed by extraction of right deciduous lateral incisor with immediate placement of a NobelActive® TiUltra™ implant and immediate provisionalisation. Simultaneous soft tissue augmentation was carried out with sub-epithelial connective tissue graft.

Case courtesy of Dr. Mankoo

Patient: 22 years, male

Clinical situation: congenitally missing right lateral and peg shaped left lateral maxillary incisor 

Surgical solution: extraction & immediate placement of NobelActive® TiUltra™ implant

Restorative solution: Temporary: SnapTemp abutment and Tempshell crown. Final: NobelProcera® ASC Full Contour Zirconia Implant Crown

Surgery date: April, 2019

Total treatment time: 3 months

Tooth position: 12

 

 

 

Case courtesy of Dr. Tidu Mankoo.

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Case courtesy of Dr. Mankoo

Initial clinical situation

Clinical view of patient with retained deciduous right maxillary lateral incisor and peg-shaped left lateral. Note the poor relative proportions of the incisors, anterior crowding and the lack of adequate space for the maxillary lateral incisors (left).

Apical root resorption of the retained right lateral incisor (right).

Case courtesy of Dr. Mankoo

Initial clinical situation

Clinical situation after 14 months of orthodontic treatment.

Case courtesy of Dr. Mankoo

Treatment planning

Digital planning of the implant placement and digitally designed TempShell in the DTX Studio™ Implant software.

Case courtesy of Dr. Mankoo

Surgical procedure

Immediate postoperative situation with temporary crown in place on a 3mm SnapTemp abutment and a connective tissue graft to augment labial volume (left).

NobelActive® TiUltra™ 3.5 x 10 mm implant (center).

Radiograph of the NobelActive® TiUltra™ implant with the SnapTemp abutment right after the surgery (right).

Case courtesy of Dr. Mankoo

Restorative procedure

At 2 months, impressions were taken (both conventional and digital) and shade communication provided to the laboratory. The temporary was refitted.

Case courtesy of Dr. Mankoo

Restorative procedure

DTX Studio™ Lab software was utilized to design the zirconia framework for a NobelProcera® ASC Full Contour Zirconia Implant Crown with labial cutback and veneered with porcelain on the labial side (work by Luc & Patrick Rutten).

Case courtesy of Dr. Mankoo

Restorative procedure

Delivery of the final prosthetic 3 months after the implant placement.

Case courtesy of Dr. Mankoo

Outcome

1 week follow-up: Intraoral view of the final restoration.

Case courtesy of Dr. Mankoo

Outcome

Clinical situation showing pleasing esthetic result after one month of follow-up (left).

Radiograph of the implant and the final prosthesis (right).

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