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.
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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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).
Initial clinical situation
Clinical situation after 14 months of orthodontic treatment.
Digital planning of the implant placement and digitally designed TempShell in the DTX Studio™ Implant software.
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).
At 2 months, impressions were taken (both conventional and digital) and shade communication provided to the laboratory. The temporary was refitted.
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).
Delivery of the final prosthetic 3 months after the implant placement.
1 week follow-up: Intraoral view of the final restoration.
Clinical situation showing pleasing esthetic result after one month of follow-up (left).
Radiograph of the implant and the final prosthesis (right).