Team Approach: Replacing Lateral Incisor

CASE REPORT
The Team Approach to Replacing the Congenitally Missing Lateral
Incisor: Restorative and Periodontal Considerations
Donald S. Clem* and Kenneth F. Hinds†
Introduction: The replacement of congenitally missing maxillary lateral incisors can be a challenge from both a restorative and surgical perspective. The restorative dentist is limited in achieving esthetics by the surgical result not only
by the implant position but by the surrounding periodontium of the site itself, as well as the adjacent teeth. The present
case, replacing congenitally missing lateral incisors with an immediate provisional restoration, is important because it
demonstrates the ideal team approach. By each clinician participating in stage I surgery, the restorative dentist and
periodontist can work toward an optimal result. The combination of restorative expertise and regenerative enhancements simultaneously can result in a minimally invasive approach with fewer appointments and greater patient
acceptance.
Case Presentation: This case report demonstrates the restorative and surgical considerations and techniques for
prefabrication of screw-retained provisional restorations placed at the time of surgery. Surgical considerations and techniques to support the restoration position, size, and screw retention connection are also presented.
Conclusions: Close communication between treatment team members is critical to achieving predictable esthetics
and function for congenitally missing maxillary lateral incisors. The participation of the restorative dentist at stage I surgery is
critical in demanding esthetic cases such as this. Periodontal hard and soft tissues respond well to prefabricated screwretained provisional restoration delivered at the time of surgery. Clin Adv Periodontics 2013;3:106-114.
Key Words: Clinical protocols; transplants.
Background
Although dental implants have arguably been considered
the most significant advancement in dentistry, there is
a lack of long-term controlled data regarding hard- and
soft-tissue complications and poor esthetic outcomes.
Kinzer and Kokich1,2 explored the clinical considerations
for choosing and achieving the most predictable esthetic
and functional result for replacing congenitally missing
maxillary lateral incisors from orthodontic, restorative,
and implant perspectives.
Clearly there are several issues with regard to implant replacement involving adequate facial lingual bone volume,
distance between implants and natural teeth, and implant
* Private practice, Fullerton, CA.
†
Private practice, Laguna Niguel, CA.
Submitted September 8, 2012; accepted for publication January 1, 2013
doi: 10.1902/cap.2013.120096
106
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
position. Although the bone volume required to support
implants may be arguable, the volume required to support
esthetic outcomes is less controversial. The study by Becker
et al.3 was one of the first to question the need for bone
grafting at the time of immediate placement of implants
at extraction. They were able to demonstrate a cumulative
success rate of 93.3% over 5 years. However, analysis of
esthetic results was not done. Schwarz et al.4 demonstrated
that there was a greater likelihood of esthetic compromise
as a result of marginal tissue recession around implants
with incomplete bone formation. Keratinized tissue and
soft-tissue thickness may be related to lower mean alveolar
bone loss. In addition, soft-tissue thickness may relate to
overall alveolar contour and may be influenced by connective tissue (CT) grafting, uncovering technique, or the contour of a provisional restoration. Grunder5 demonstrated
a significant increase in overall facial contour thickness
in those cases grafted with CT grafts to enhance soft tissue
around implants. Considerations with regard to the
C A S E
interdental and interimplant papilla rely on both the periodontal condition of the adjacent teeth and the interimplant
or implant–tooth distance. It is generally accepted that the
height of the interproximal papilla is primarily dependent
on the height of the papilla and bone of the adjacent natural
tooth. Ideally, interimplant/implant–tooth distance should
be 1.5 to 2 mm at a minimum.6 Although the implant–tooth
horizontal distance reported as ideal is small, ranging from
1.5 to 2 mm, the significance to esthetic outcome may be
large. If one considers that the smallest implant diameter
used in this case report is 3.3 mm, that means that one should
strive for a site that demonstrates 6.3 to 7.3 mm of space in
the proposed lateral incisor space.
Immediate delivery of provisional restorations at the
time of implant placement, although challenging, can have
a predictable outcome on esthetics, integration, and patient
satisfaction.7,8 The question of implant stability at insertion has been the subject of several papers.9,10 Radio frequency analyses expressed as implant stability quotient
(ISQ) readings have been associated with implant stability
and the predictability of osseointegration. Nedir et al.11
demonstrated that ISQ values ‡47 for implants at the time
of insertion translated to predictable and maintainable osseointegration.11 The implant position in a facial palatal direction is determined presurgically to diagnose restoration
design, cementable or screw retained. If a screw-retained
restoration is selected, the position of the implant must allow for screw access without compromising facial contour
and material strength. Once this position is determined by
the restorative dentist, the periodontist must evaluate the
proposed site with regard to adequate interradicular distance, facial bone contour, soft tissue, and alveolar bone
height. Immediate provisionalization can be considered
once implant stability is determined.8,12 The purpose of this
report is to demonstrate how the periodontist–restorative
dentist team can work together at stage I surgery to plan,
fabricate, and insert screw-retained provisional restorations, while simultaneously managing the surgical and restorative complexities of replacing congenitally missing
lateral incisors with implants.
Clinical Presentation
A 22-year-old female patient presented to the restorative
office (KFH) in March 2009 with congenitally missing
maxillary lateral incisors, Class I occlusion, and recent
post-orthodontic treatment with an over-retained primary tooth present on the right side and missing primary
tooth on the left. The patient’s chief complaint was “I
want to have adult teeth that look good.” Review of
her medical history was non-contributory, and the patient
was classified as an American Society of Anesthesiologists
Category I healthy patient.13 Her only previous dentistry
apart from routine maintenance and minor restorative
care was the recent completion of orthodontics. Clinical
and radiographic evaluation revealed a normal periodontium with good intercuspation of teeth and acceptable
alignment of the maxillary anterior segment. The mesial–distal spaces of the maxillary lateral incisors (#7
Clem, Hinds
R E P O R T
and #10) appeared equal, but site #10 demonstrated a significant facial contour deficiency. As a result, the implant
sites were significantly different in both alveolar bone width
and height (Fig. 1). Facial–lingual alveolar width for both
sites were deemed adequate for implant placement as determined by cone-beam computerized tomography. The patient also expressed a desire to avoid the continuation of
a removable temporary device during the healing phase after
implant placement. Considerations with regard to treatment
options were discussed in detail with the patient and her
mother, and written and oral informed consent was provided regarding options for tooth replacement, timing,
and provisionalization.
Case Management
Because of the demanding esthetic and functional requirements of this patient, the treatment team consisting of the
periodontist (DSC) and restorative dentist (KFH) outlined
a plan that could potentially result in high predictability of
these requirements with low risk.
Restorative Preparation
Presurgical study cast planning and accurate surgical
guide fabrication were essential to assist in the proper
placement of implants and indirect provisional fabrication. Proper planning, spacing, and instructions to the
laboratory technician were critical before fabrication of
the surgical guide. The key elements for surgical guide design (Fig. 2) and indirect provisional fabrication are outlined below (Figs. 3 and 4).
Material. Rigid clear orthodontic acrylic resin supported by the occlusal surface of the adjacent teeth similar
to an occlusal guard was used. A rigid design was beneficial
presurgically for accurate placement of the implant replicas
into the study cast, which was used for provisional fabrication prior to stage I surgery.
Designate access opening for implant site/sites. A
3-mm access opening was made on the surgical guide to locate the target location for each implant site. Ideal emergence for a cement-retained restoration is through the
incisal edge and modified based on alveolar ridge contours.
Indirect provisional fabrication. Using the surgical
guide, a 3-mm opening was drilled in the study casts (laboratory osteotomy was performed) completely through the
stone. The temporary abutment was marked with a vertical
line to designate the flat portion of the connector (represents facial position) and a horizontal line to mark the tissue depth of 3 mm at the midfacial position. The temporary
abutment was connected to the implant replica and placed
in the study cast to the designated depth and orientation.
The replica was set into the cast from the underside with
a fast-set, self-curing acrylic resin.‡ A screw-retained
provisional restorationx was fabricated to estimated contours (Figs. 3 and 4).
‡
x
GC pattern resin, GC America, Alsip, IL.
NC Temporary Abutment, Straumann, Andover, MA.
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
107
C A S E
R E P O R T
FIGURE 1 Preoperative photographs (1a and 1b) and panoramic
radiograph (1c) of a 22-year-old female patient presenting with congenitally
missing maxillary lateral incisors with an over-retained primary tooth
present on the right side and missing primary tooth on the left. As a result,
the implant sites were significantly different in both vertical and horizontal
dimensions.
Surgery
At surgery, the patient was premedicated with 1.5 g amoxicillin given the day before surgery. She fasted at least
6 hours before surgery. She was positioned in a semisupine
position, and an intravenous infusion was established in
the left hand. One hundred milligrams pentobarbital||
and 3 mg midazolam{ were titrated to a level of moderate
sedation. One hundred forty-four milligrams lidocaine
with 0.072 mg epinephrine were given as local infiltrations.
A full-thickness flap was established on the facial aspect of
the maxillary anterior segment extending from the mesial
aspect of the maxillary left bicuspid to the mesial aspect of
the maxillary right bicuspid. Care was taken to only involve the facial aspect of the associated papillae and to
avoid vertical incisions. Lingual flap reflection was accomplished in the lateral incisor areas to gain access to the
108
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
lingual alveolus (Video 1). Next, a surgical guide was
placed, and initial osteotomies were established with a
2-mm twist drill. An intraoperative radiograph was then
taken to verify implant trajectory with respect to the adjacent teeth. In addition, the apical position of the implant
was verified against the surgical guide in an effort to place
the implant far enough apically to allow for ideal emergency profile of the implant restoration through the overlaying soft tissue (Video 2).
Finally, the internal flat side of the implant# profile was
lined up against the facial plate in an effort to allow for
seating of the prefabricated provisional crown with
screw-retained retention and engaging the anti-rotational
features of the implant.
Implant site #10. For this site, the implant position
met all of the above requirements. In addition, the ISQ
was 64 at the time of placement. However, when evaluating the facial contour, the shadow of the facial aspect
of the implant was visible as a result of the lack of facial
contour in the alveolus. This was grafted with mineralized freeze-dried bone allograft (FDBA)** and a long-term
resorbable collagen membrane†† (Fig. 5).The provisional
was placed, the position was verified, and the final
contacts were added with light-cured composite. The provisional restoration was then hand tightened to place
using z10 Ncm.
Implant site #7. Surgical placement of this implant
mimicked the surgery for site #10 with one major difference. After initial seating of the provisional restoration,
it was determined that the gingival emergence was not consistent with the rest of the anterior segment, demonstrating
a position that was too far in the coronal direction (Video
3). This was because the alveolar ridge at site #7 was coronal to the adjacent natural teeth. This is a common condition of these sites. Alveoloplasty and osseous crown
lengthening was performed to allow for adjustment of
the apical position of the implant. This was dictated by
the prefabricated provisional restoration. The ISQ reading for this fixture was 68. The facial and lingual flaps
were then repositioned and sutured with individual,
interrupted 6-0 polyglactin 910 sutures.‡‡ Care was
taken to ensure that the provisional restorations were
kept out of occlusion in centric occlusion and all excursive movements. The patient was administered 60 mg
ketorolacxx intravenously and given a non-steroidal antiinflammatory drug for post-operative pain. She was dismissed in alert and stable condition to the care of her
mother. She was told not to brush the areas and only to
swab the sites with water until her next visit which was
in 2 weeks (Video 4).
||
Nembutal, Lundbeck, Deerfield, IL.
Versed, Novell Pharmaceutical, West Jakarta, Indonesia.
#
3.3 Bone Level Roxolid implant, Straumann.
** LifeNet Health, Virginia Beach, VA.
††
OSSIX PLUS, OraPharma, Horsham, PA.
‡‡
VICRYL, Ethicon, Johnson & Johnson, Cornelia, GA.
xx
Toradol, Apotex, Toronto, Ontario.
{
Team Approach for Replacement of Maxillary Laterals
C A S E
R E P O R T
FIGURE 3a and 3b Temporary abutment marked with a vertical line
designating the flat portion of the connector and facial position and
a horizontal line designating the implant depth. 3c and 3d A 3-mm opening
was drilled completely through the cast at the desired implant sites using
the surgical guide. A temporary abutment was attached to an implant
replica and positioned into the study cast at the estimated final position.
The replicas were set with pattern resin from the bottom of the cast.
Immediate Provisionals
FIGURE 2a and 2b Study casts marked accurately to designate proper
implant site and spacing. 2c and 2d Surgical guide fabricated with hard
clear orthodontic acrylic resin and supported by occlusal surface of
adjacent teeth similar to an occlusal guard. The facial gingival most apical
aspect of the guide for each implant site must be made accurately to
represent desired final gingival margin. The surgeon will use the guide to
measure 3 mm apical to set the proper implant depth.
Clem, Hinds
After fixture placement, provisionals were placed one at a time
starting with site #10 (Video 5). First, the surgeon (DSC) confirmed that the implant fixture flat portion of the internal connector was oriented to the facial aspect so that the provisional
would fit as designed. The restorative team member (KFH) altered the contact points, incisal length, and lingual surface before bone augmentation and closure of the surgical site. The
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
109
C A S E
R E P O R T
FIGURE 4a and 4b Indirect screw-retained provisionals fabricated with
temporary abutments and composite resin.
mesial contact on both provisionals was closed with the addition of composite resin and repolished. Care was taken to ensure that the contact points were not too tight, which may
cause micromovement on the implants and produce a negative
effect on integration. Dental floss was used to ensure proper
contact. Immediate provisionals are typically shorter than
the definitive restoration to avoid contact in centric or any excursive movements (Fig. 6).
When planning for the use of immediate provisionals, the
team must be prepared if placement is not possible because
of the following challenges: 1) unfavorable implant stability
(low ISQ readings); 2) unfavorable occlusion; 3) unfavorable site; 4) provisional not fitting; 5) abutment not seating;
6) implant position; or 7) implant appears loose. Alternatives include the following. 1) Make an implant transfer index to study cast, the restorative team makes minor
modifications, and deliver the same day. 2) Reduce provisional to the gingival level to create a custom healing abutment and place a vacuum-formed retainer. In 2001, Garber
et al.14 reported a custom healing abutment as an alternative
to the full contoured provisional, which provided preservation of soft tissue and prevented any unfavorable occlusal
trauma and micromovement. 3) Make an index impression
for early loading, place a vacuum-formed retainer, and deliver the corrected provisional within 2 to 14 days. 4) Make
an index impression for delayed loading, place a vacuumformed retainer, and deliver the provisional in 6 to 24 weeks.
Clinical Outcomes
Final Radiographs, Tissue Healing, and
Clinical Photographs
The 2-week postoperative visit demonstrated normal
healing of the soft tissues with some edema in the tissues
110
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
FIGURE 5 After fixture placement and provisionals in sites #7 and #10
(5a), the facial aspect was grafted with mineralized FDBA (5b) and a longterm resorbable collagen membrane (5c).
still present. Of note was site #10, which demonstrated
thickened, bulky contours with soft-tissue cratering interproximally. No recontouring of either the provisional
or soft tissue was done, and the areas were allowed to
mature unaided. The patient was instructed in using
a soft toothbrushing technique with light interproximal
flossing.
At 4 months, the patient demonstrated excellent soft-tissue response to the provisional restorations and healthy,
stable interproximal papilla. Periapical radiographs were
taken to verify healing of the implant fixtures, and definitive impressions were initiated using the “custom
Team Approach for Replacement of Maxillary Laterals
C A S E
R E P O R T
FIGURE 7 At 4 months of provisional healing (7a), the definitive impression
was made using custom impression coping (7b) and poured in die stone to
create an accurate master cast.
FIGURE 6 Screw-retained provisionals placed at stage I surgery (6a and
6b) and at 18 days of healing (6c).
impression coping technique” reported by Hinds in
1997.15 Provisionals were removed one at a time, and
pickup impression copings were modified with composite
resin and connected to the implant fixture. The composite
was contoured directly in the implant sites and light cured
to harden the material. The impression copings were then
removed and inspected, and composite resin was added to
fill any voids and polished. As a result, the copings should
accurately represent the healed soft tissue created by the
provisional restoration (Fig. 7).
The custom impression copings were reconnected to
the fixture level, and an open-tray polyether‖‖ impression
was made. Implant replicas were connected to the impression copings, and the impression was poured in die stone
to create a master cast. All-ceramic, zirconia computeraided design/computer-aided manufacturing (CAD/CAM){{
abutments and all-ceramic, zirconia restorations were
fabricated (Fig. 8).
The definitive abutments were connected and torqued
to 35 Ncm. A cotton pellet and elastic, single component
light-cured resin## was used to close the abutment access
opening. The definitive prostheses were cemented with radiopaque glass ionomer luting cement*** (Fig. 9). To
avoid complications with residual subgingival cement,
the following protocol was followed.
Clem, Hinds
FIGURE 8 Definitive all-ceramic CAD/CAM zirconia abutments (8a) and
cementable all-ceramic prostheses (8b) for implant sites #7 and #10. Allceramic porcelain veneers for central incisors #8 and #9.
Protocols for Anterior Cement-Retained
Prosthesis
Provisional restorations. One-piece screw-retained provisional restoration was essential to develop proper soft-tissue
contours, interdental papilla, and facial margin before the
fabrication of the definitive prosthesis.
‖‖
Impregum, 3M ESPE, St. Paul, MN.
NobelProcera CAD/CAM scanner, Optimet Metrology, North Andover, MA.
##
Telio CS Inlay Syringe Transparent, Ivoclar Vivadent Amherst, NY.
*** Ketac glass ionomer cement, 3M ESPE.
{{
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
111
C A S E
R E P O R T
FIGURE 9 Clinical photographs (9a and 9b) and radiographs (9c and 9d)
of definitive prostheses at 1 month.
Custom impression coping. After soft-tissue healing,
custom impression copings16 were used to make an accurate transfer, allowing the technician the opportunity to
fabricate the abutment margins more precisely, eliminate
guessing, and avoid deep subgingival margins from which
excess cement may be difficult to remove (Fig. 7).
Abutment design (Fig. 8). 1) All-ceramic abutments
(zirconia) provided the advantage over metal abutments
of less gray/darkness displaying through the facial tissue
and allowed prosthetic margins to be designed more shallow. Although zirconia abutments are currently manufactured primarily white, the shade can be modified with
pressed ceramics17 or layered porcelain techniques. Marchack and Yamashita18 reported in 1997 a modified custom
abutment with a 360˚ porcelain collar as another alternative to all-ceramic abutments. 2) The facial margin was 5
mm below gingival crest. 3) The interproximal margin
was even with the gingival crest. 4) The palatal margin
was 1 mm coronal to the gingival crest.
Discussion
The term “team approach” has been used throughout the
health care industry, and as technologies continue to advance, this term has evolved from simply referring a patient
back and forth to detailed treatment planning and case selection. In this case report, the restorative dentist presence
and participation at stage I surgery was a valuable asset to
achieving the ideal esthetic and functional result for this
patient.
Once adequate bone for implant placement was determined using cone-beam computerized tomography, distances between adjacent teeth were verified with the
scan. In this case report, the space between teeth measured
6.3 mm; thus, 3.3-mm-diameter implants were used. The
facial gingival-most apical aspect of the guide for the designated implant site must be fabricated accurately to
112
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
represent desired final gingival margin of the definitive restoration. The surgeon will use the guide to measure 3 mm
apical to set the proper implant depth. With this particular
patient displaying uneven gingival heights from right to
left, the guide provided a critical reference for fixture placement.16,19 When designing the surgical guide, the direction/
angle of the access opening may be affected by prosthetic
design. The restorative team member must determine
whether the definitive restoration will be cement or screw
retained. There is currently significant discussion about cement-retained restorations contributing to the causes of
peri-implantitis.17,20 For this reason, some clinicians have
abandoned cement-retained implant restorations. Screwretained implant prosthesis may require an implant placement in a more palatal position. This could have a negative
effect on the final esthetic result. Although a screw-retained
restoration avoids the complication of excess cement, it
adds an additional degree of difficulty because of the small
margin of error for implant placement. Cement-retained
restorations allow implant placement in an ideal position
based on available bone, ability to augment ridge, proper
depth to create ideal transitional profile, and proper mesial–distal spacing and not on prosthetic design. Any necessary correction in angle in a facial–palatal direction is
made with the custom-contoured abutment. In 2012,
Wadhwani et al.17 reported the most effective method to
avoid excess cement with cementable restorations was to
avoid subgingival margins. The authors recommended
supragingival abutment–implant crown margins. In addition, it was recommended that the materials used on the
abutment is the same shade of the prosthesis to avoid detection on recession on the facial aspect.
Replacement of maxillary incisors with implants requires a thorough understanding of the periodontal anatomy, regenerative potential of bone and soft tissue, and
the biomaterial principals of the restorative techniques
used. In this case report, positioning of implant analogs
in the ideal positions on a diagnostic cast before surgery
was key in fabricating a surgical guide to aid the periodontist in implant positioning. With the restorative dentist
present, an additional skill set to compliment the regenerative and surgical esthetic techniques used resulted in
highly accurate, reproducible implant positions so that prefabrication of provisional crowns could be accomplished.
These crowns engaged the anti-rotational features of the
implants that were verified as “stable” based on ISQ values
>60. Screw retention of the provisional restorations
avoided the possibility of cement migration and allowed
for guided bone regeneration (GBR) to be performed
around implant #10 simultaneously. Long-term implant
success using GBR has been documented by a number of
authors, and bone allografts have also been shown to allow
for up to 42% new bone formation at 6 months.21,22
Clearly, the amount of bone required for integration and
implant stability is less than that needed for ideal implant
position and soft-tissue contours. This bony support of
soft-tissue contour can be an advantage as well as a disadvantage, as demonstrated by this case. For example,
Team Approach for Replacement of Maxillary Laterals
C A S E
because of the coronal position of the alveolar crest in site
#7, periodontal surgical crown lengthening was required to
reposition the implant more apically, dictated by the surgical guide. For site #10, although the implant was positioned accurately to allow for a cementable definitive
restoration, the facial contour of bone was depressed
and thin. GBR was used in an effort to prevent facial bone
loss and to expand the soft-tissue contour over the implant
restoration. Full-thickness flaps without vertical incisions
in this case report had the advantage of avoiding any
soft-tissue scaring from vertical incisions, allowing for manipulation of soft tissue by repositioning and coronal advancement over the idealized provisional and, of course,
facilitating the regenerative and crown-lengthening surgery.
R E P O R T
This would not have been possible if a flapless technique
were used, and there would be a strong likelihood that
the final restorative results would be compromised although
integration would have been successful. In addition, this
case demonstrates that highly accurate restorative and surgical procedures can be accomplished without the use of
computer-generated guides.
Ultimately, it is the team approach that accounts for the
esthetic and functional success of this case, taking advantage of the synergy of working together to maximize each
clinician’s skill in contributing to the best, most predictable, least invasive outcome for the patient. The authors’
experience shows that this approach has high predictability
and high patient acceptance. n
Summary
Why is this case new information?
What are the keys to successful
management of this case?
What are the primary limitations to
success in this case?
j
Prefabrication of provisional implant restorations can be done without
the use of computer-generated surgical guides and allow for
regenerative/esthetic surgery to support both implant stability and
soft-tissue contour before the definitive restoration.
Close communication and planning between the periodontist and the
restorative dentist before executing the surgical plan
j Periodontist and restorative dentist participating in stage I surgery for
highly demanding esthetic cases
j Verified implant stability
j Extended healing time to allow for tissue maturation
j
j
j
Adequate bone for proper implant position
Accurate surgical guides to communicate implant position in four
perspectives: axial, sagittal, apical, and rotational
Acknowledgements
Dr. Clem has received honoraria from Straumann (Andover,
Massachusetts). Dr. Hinds reports no conflicts of interest related to this case report.
Clem, Hinds
CORRESPONDENCE:
Dr. Donald Clem, 220 Laguna Rd., Suite 3, Fullerton, CA 92635. E-mail:
dscdds@aol.com.
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
113
C A S E
R E P O R T
References
1. Kinzer GA, Kokich VO Jr. Managing congenitally missing lateral incisors.
Part II: Tooth-supported restorations. J Esthet Restor Dent 2005;17:76-84.
2. Kinzer GA, Kokich VO Jr. Managing congenitally missing lateral incisors.
Part III: Single-tooth implants. J Esthet Restor Dent 2005;17:202-210.
3. Becker BE, Becker W, Ricci A, Geurs N. A prospective clinical trial of
endosseous screw-shaped implants placed at the time of tooth extraction without augmentation. J Periodontol 1998;69:920-926.
4. Schwarz F, Sahm N, Becker J. Impact of the outcome of guided bone
regeneration in dehiscence-type defects on the long-term stability of
peri-implant health: Clinical observations at 4 years. Clin Oral
Implants Res 2012;23:191-196.
5. Grunder U. Crestal ridge width changes when placing implants at the
time of tooth extraction with and without soft tissue augmentation
after a healing period of 6 months: Report of 24 consecutive cases. Int
J Periodontics Restorative Dent 2011;31:9-17.
6. Elian N, Bloom M, Dard M, Cho SC, Trushkowsky RD, Tarnow D. Effect
of interimplant distance (2 and 3 mm) on height of interimplant bone
crest: A histomorphometric evaluation. J Periodontol 2011;82:1749-1756.
7. Harvey BV. Optimizing the esthetic potential of implant restorations
through the use of immediate implants with immediate provisionals.
J Periodontol 2007;78:770-776.
8. Becker CM, Wilson TG Jr., Jensen OT. Minimum criteria for immediate
provisionalization of single-tooth dental implants in extraction sites: A
1-year retrospective study of 100 consecutive cases. J Oral Maxillofac
Surg 2011;69:491-497.
9. Rasmusson L, Thor A, Sennerby L. Stability evaluation of implants
integrated in grafted and nongrafted maxillary bone: A clinical study
from implant placement to abutment connection. Clin Implant Dent
Relat Resil 2012;14:61-66.
10. Park KJ, Kwon JY, Kim SK, et al. The relationship between implant
stability quotient values and implant insertion variables: A clinical
study. J Oral Rehabil 2012;39:151-159.
11. Nedir R, Bischof M, Szmukler-Moncler S, Bernard JP, Samson J.
Predicting osseointegration by means of implant primary stability. Clin
Oral Implants Res 2004;15:520-528.
12. Buser D, Wittneben J, Bornstein MM, Grütter L, Chappuis V, Belser
UC. Stability of contour augmentation and esthetic outcomes of
implant-supported single crowns in the esthetic zone: 3-year results of
a prospective study with early implant placement postextraction.
J Periodontol 2011;82:342-349.
13. Maloney WJ, Weinberg MA. Implementation of the American Society
of Anesthesiologists Physical Status classification system in periodontal
practice. J Periodontol 2008;79:1124-1126.
14. Garber DA, Salama MA, Salama H. Immediate total tooth replacement. Compend Contin Educ Dent 2001;22:210-216, 218.
15. Hinds KF. Custom impression coping for an exact registration of the
healed tissue in the esthetic implant restoration. Int J Periodontics
Restorative Dent 1997;17:585-591.
16. George FM, Chan HL, Razzoog ME, Oh TJ. Fabrication of a castbased implant surgical guide using guide sleeves. J Prosthet Dent 2011;
106:409-412.
17. Wadhwani CP, Piñeyro A, Akimoto K. An introduction to the implant
crown with an esthetic adhesive margin (ICEAM). J Esthet Restor Dent
2012;24:246-254.
18. Marchack CB, Yamashita T. A procedure for a modified cylindric
titanium abutment. J Prosthet Dent 1997;77:546-549.
19. Pesun IJ, Gardner FM. Fabrication of a guide for radiographic
evaluation and surgical placement of implants. J Prosthet Dent 1995;
73:548-552.
20. Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P. Does
residual cement around implant-supported restorations cause periimplant disease? A retrospective case analysis [published online ahead
of print August 8, 2012]. Clin Oral Implants Res doi:10.1111/j.16000501.2012.02570.x.
21. Nevins M, Mellonig JT, Clem DS 3rd, Reiser GM, Buser DA. Implants
in regenerated bone: Long-term survival. Int J Periodontics Restorative
Dent 1998;18:34-45.
22. Cammack GV 2nd, Nevins M, Clem DS 3rd, Hatch JP, Mellonig JT.
Histologic evaluation of mineralized and demineralized freeze-dried
bone allograft for ridge and sinus augmentations. Int J Periodontics
Restorative Dent 2005;25:231-237.
indicates key references.
114
Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013
Team Approach for Replacement of Maxillary Laterals