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A Perio-Implant-Prosthodontic Approach for Zenith-Driven Rehabilitation of Upper Anterior Teeth

This case report is authored by Dr Fausto Frizzera et al. for a patient who suffered oblique fracture of 21 and needed immediate replacement. Zenith-driven rehabilitation was planned which required crown lengthening in 12 and 13. Extraction of 21 was done followed by provisional crown which had a concave subgingival contour without occlusal contacts. The implant needed bone and soft tissue grafting. Crown lengthening in 12 and 13 was done 90 days from the implant procedure. This patient-tailored treatment plan was adequate for patient's satisfaction, esthetics, function and long-term stability. It is a multidisciplinary approach between professionals from different dental specialties with Digital Smile Design (DSD) which allowed for involving the patient in the planning process. Ideal gum position is an important factor to determine the need for doing other procedures such as surgery or orthodontics in the treatment process.

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Oblique fracture of 21 caused by occlusal trauma. The patient had deep periodontal pocket, thin biotype, short clinical crowns in 13 and 12 and buccal bone loss.
Evaluation of the upper anterior teeth reveled that there was ab alteration of teeth form, zenith position of 13 and 12 and the need to preserve the marginal tissue of 21 after replacement.
Atraumatic extraction and drilling in the palatal bone wall for 3.5 × 13 mm implant installed 4 mm subgingival.
Thick connective tissue graft sutured internally in the socket with the buccal tissue and retained with non-cross-linked membrane which was trimmed and placed in contact with the graft and the apical portion of the socket. Inorganic bovine bone graft containing 10% porcine collagen was used to reconstruct the socket.
The reconstructed socket before provisionalization (occlusal view).
Demonstration of the sequence of the reconstruction of the socket and the provisional (lateral view).
15 days after provisionalization with stable gum contour.
Flapless crown lengthening to reposition the zenith in 12 and 13. Micro-Chisel and curette were used for bone removal to create 3-mm distance between the gum margin and the bone crest.
Customized zirconia abutment with a subgingival concave contour was used.
(a) Preparation of 11 for all ceramic restorations (a). (b) CBCT showing osteointegration and dense gingival tissue 1 year after replacement. (c) post-operative image of the anterior teeth, restored with zenith-driven rehabilitation.
4-year follow up.
Avatar
Case Masters

A Perio-Implant-Prosthodontic Approach for Zenith-Driven Rehabilitation of Upper Anterior Teeth

This case report is authored by Dr Fausto Frizzera et al. for a patient who suffered oblique fracture of 21 and needed immediate replacement. Zenith-driven rehabilitation was planned which required crown lengthening in 12 and 13. Extraction of 21 was done followed by provisional crown which had a concave subgingival contour without occlusal contacts. The implant needed bone and soft tissue grafting. Crown lengthening in 12 and 13 was done 90 days from the implant procedure. This patient-tailored treatment plan was adequate for patient's satisfaction, esthetics, function and long-term stability. It is a multidisciplinary approach between professionals from different dental specialties with Digital Smile Design (DSD) which allowed for involving the patient in the planning process. Ideal gum position is an important factor to determine the need for doing other procedures such as surgery or orthodontics in the treatment process.

Please rate this case
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