A clinical case by our Community member Dr. Matteo Bordin
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
The rehabilitation of a missing maxillary central incisor represents a significant challenge due to the high esthetic demands of the anterior maxilla. Digital workflows and guided implant surgery allow for precise implant placement, improved prosthetic outcomes, and reduced surgical morbidity. This case report describes the implant-prosthetic rehabilitation of tooth 11 using a fully guided surgical approach.
Fig.1
A 67 year old male patient presented with a missing teeth in right central incisor (tooth 11) due to a traumatic coronal fracture. The patient was in good systemic health, a non-smoker, and expressed a strong desire for an esthetic and minimally invasive treatment.
Fig.2
An intraoral scan and cone beam computed tomography (CBCT) were obtained and merged using implant planning software.
The digital workflow included:
- Prosthetically driven implant planning.
- Virtual positioning of the implant according to the planned emergence profile.
- Evaluation of the surrounding anatomical structures.
- Design and fabrication of a tooth-supported surgical guide using 3D printing technology.
Fig.3
Under local anesthesia, atraumatic extraction of tooth 11 was performed while preserving the socket walls.
Fig.4
Using the surgical guide, a guided osteotomy sequence was carried out according to the manufacturer’s protocol.
Fig.5
Dental tech FTK implant (3.75 × 13 mm) was inserted guided with a final insertion torque of 45 Ncm, allowing immediate provisionalization.
The implant was placed in reference to the projected screw retained crown; the implant was placed 1,0 mm below the bone crest, and an intermediate abutment of 2,0 mm.
Fig.6
A screw-retained provisional crown was fabricated based on the digital wax-up and delivered immediately after surgery.
The provisional restoration was designed:
Without centric or eccentric occlusal contacts.
To support peri-implant soft tissue healing.
To guide the development of an ideal emergence profile.
Fig.7
Soft tissue integration, six months after surgery, the biological peri-implant width are stable and the vestibular plate is maintained. The papillae are competent, and the parabola is symmetrical to the adjacent tooth.
Fig.8
A monolithic zirconia crown with a concave emergence profile was delivered. The restoration exhibits a smooth, highly polished cervical contour designed to provide adequate soft-tissue support while promoting peri-implant tissue health and facilitating oral hygiene. The crown presents a natural tooth-like anatomy and shade, with a transmucosal profile that transitions gradually from the prosthetic platform to the cervical portion of the restoration.
Fig.9
The peri-implant soft tissue architecture remained harmonious and stable, with well-maintained marginal tissue levels and complete interdental papilla fill, contributing to a favorable pink esthetic outcome.
Fig.10
The definitive restoration demonstrated a well-developed emergence profile, allowing for a natural transition between the prosthetic crown and the peri-implant tissues. The restoration showed excellent integration with the adjacent dentition in terms of morphology, contour, and color, while the cervical profile provided adequate support for the surrounding soft tissues and facilitated oral hygiene procedures.
Conclusions
The use of a fully digital workflow combined with guided implant surgery enabled predictable rehabilitation of tooth 11 with excellent esthetic and functional outcomes. Accurate implant positioning, immediate provisionalization, and careful prosthetic management were key factors in the success of this treatment.
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