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    How to place an anterior implant using a digital workflow

    One practitioner demonstrates how to replace a central incisor using socket shield technique.

    The patient, a 48-year-old female, is in good general health with no known diseases and not taking any medication. She is a non-smoker with no allergies.

    The patient is suffering from the continuous decimation of her crown on the central incisor (Fig. 1). Once the crown is removed, we can see that the remaining stump has subgingival margins and the typical appearance of having suffered continued leaks.

    Related reading: How the digital workflow will enhance communication and reliability

    The patient’s smile has a high lip line (Fig. 2), shows all incisors and about 4 mm of gum. The restoration requires a highly esthetic result, as any fault would be clearly visible. Patient biotype was average and not very scalloped.

    Fig. 1Fig. 2

    Fig. 1                                                                                                Fig. 2

    Treatment plan

    The patient was presented with five treatment options:

    1. The first option was to reconstruct the stump and make a new crown. This, however, would not guarantee a predictable treatment in the medium to long-term.  

    2. The second option was a Maryland bridge together with an alveolar preservation and connective tissue graft. This option was dismissed as the adjacent pieces of a fixed ceramic prosthesis would seriously compromise the adhesion of the Maryland bridge.

    3. Option three was an alveolar preservation after the extraction and the subsequent implant placement after 4-5 months in conjunction with a connective tissue graft if necessary.

    4. The fourth option, placing the implant early, typically 4-8 weeks after the extraction, was a predictable long-term option with acceptable aesthetic results (Buser 2013).

    5. The fifth option, immediate implant, with or without immediate provisionalization and within the immediate procedure, using socket shield technique, was considered the best option. The patient agreed on option five.

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