Implant Rehabilitation in the Aesthetic Zone

A 51-year-old musician presented seeking fixed solutions to replace the upper central incisors that were traumatically lost 3 years ago. Periodontal disease was well-maintained; however, generalised recession and the presence of small black triangles was observed.

To aid prosthodontically-driven treatment planning, a diagnostic wax-up was transferred intraorally to determine optimal tooth positions. After satisfying all aesthetic and functional requirements, the diagnostic model was integrated into the CBCT data via an implant planning software. Initial planning revealed that the ideal implant position for a screw-retained prosthesis would require extensive bone augmentation procedures.

After discussion with the patient and referring clinician, a decision was made to place the implants within native bone as the literature reports more stable and predictable long-term outcomes compared to implants placed in grafted bone. In addition, this avoids bone augmentation procedures and morbidity, and reduces overall treatment time.

An implant system (Nobel Replace Conical Connection) that supported a customised direct-to-fixture implant bridge with angle correction (NobelProcera) was selected. This allowed placement of screw access holes on the palatal aspect to create a retrievable prosthesis with optimal aesthetics. A highly aesthetic and robust restoration was achieved as porcelain was layered directly onto the customised zirconia framework (without the use of cements) while maintaining a titanium implant-abutment connection.