CASE REPORT

Replacement of mandibular central

incisors with implant-supported
crowns: a case report
Daniel Bäumer, Dr. med. dent.
Hürzeler/Zuhr, Private Practice/Research & Education Center, Munich, Germany

Otto Zuhr, Dr. med. dent.

Hürzeler/Zuhr, Private Practice/Research & Education Center, Munich, Germany
Department of Periodontology, Johann Wolfgang Goethe University, Frankfurt am Main,
Germany

Markus Hürzeler, Prof. Dr. med. dent.

Hürzeler/Zuhr, Private Practice/Research & Education Center, Munich, Germany
Department of Operative Dentistry and Periodontology, Albert-Ludwigs University, Freiburg,
Germany

Correspondence to: Dr. Daniel Bäumer

Hürzeler/Zuhr, Private Practice/Research & Education Center, Rosenkavalierplatz 18, 81925 München;

Tel.: 0049-89-1891750; Fax: 0049-89-18917528; E-mail: daniel@dr-baeumer.com

204
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3


Abstract
Anterior teeth are often affected by ac-
cidental dental trauma and may even-
tually be lost. When the neighboring
teeth are unharmed, implant-supported
crowns are often the preferred treatment
choice. When not only the teeth but also
the supporting hard and soft tissue has
been lost, surgical reconstruction may
be needed. However, in combined hori-
zontal and vertical class III defects, the
BÄUMER ET AL
available augmentation techniques are
often not predictable. In this case report,
two neighboring mandibular central inci-
sors were replaced by two implants after
soft and hard tissue augmentation with
the cortical bone plate method. The in-
terdental soft tissue was reconstructed
with remarkable success, making this
an example of what can be achieved in
cases such as this.
(Int J Esthet Dent 2016;11:204–218)
205
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT
Introduction
Anterior teeth are often affected by acci-
dental dental trauma.1,2 In many cases,
a substantial part of the crown is dam-
aged and requires endodontic and re-
storative treatment, or even extraction of
the teeth, with the need for prosthetic
replacement.
Missing incisors can be replaced with
conventional fixed partial dentures (FP-
Ds), adhesive FPDs, or implant-support-
ed crowns. Often, in cases of accidental
damage the neighboring teeth remain
unharmed, so their preparation as abut-
ment teeth would be highly invasive and
increase the risk of subsequent biologic-
al complications such as pulpitis.3 In
gaps with more than one missing tooth,
there may be unfavorable physics for
FPDs in the anterior zone. For these rea-
sons, the preferable treatment choice to
replace teeth in some cases is implant
restorations, which can have satisfying
functional and esthetic results.
Not only can accidental trauma cause
the loss of teeth, but due to the post-
traumatic resorption and remodeling
process, a significant reduction of part
of the surrounding tissue such as bone
and soft tissue can occur.
In most
cases, this will result in complicated
deficits requiring horizontal and/or verti-
cal bone augmentation prior to implant
placement. While horizontal defects can
be reconstructed predictably,7 the re-
construction of vertical defects has an
unfavorable prognosis. A classification
of tooth gaps can therefore relate to the
bone level of the neighboring teeth and
the number of teeth to be replaced: A
class I defect is characterized by the
loss of a single tooth and a bone level
206
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

of about 1 mm from the cementoenamel
junction of the neighboring teeth, while
in a class II defect, this distance is more
than 1 mm. A class III defect would, in
this context, have more than one miss-
ing tooth, which has the worst prognosis
for a good esthetic outcome.
For single-tooth gaps with tissue de-
fects, many predictable guidelines have
been described for implant solutions.8-11
However, under current circumstances,
the replacement of two neighboring teeth
in the esthetic zone is still a major chal-
lenge. Different approaches have been
described to handle this challenging sit-
uation: guided bone regeneration (GBR)
with autologous bone particles and/or
bone replacement materials, in com-
bination with ePTFE membranes;12,13
autologous bone blocks with or without
membranes;14,15 the cortical bone plate
method, introduced by Khoury; the sand-
wich technique; and the distraction
technique.17,18 For class III defects with
multiple missing teeth, the documented
techniques all have an unfavorable prog-
nosis. In these situations, compared to
the single-tooth gap, there is no tooth
with a healthy periodontium on the me-
sial and distal sides of the implants, but
on only one of the two sides. None of the
techniques have a predictability that is
as high as that for single implants.
This article describes a patient case
in which the two mandibular central in-
cisors were missing and were replaced
with implant-supported single crowns
after hard and soft tissue augmentation.
The interdental soft tissue could be re-
constructed with remarkable success.
It is therefore an example of what can
be achieved, and what future concepts
should strive for.
 BÄUMER ET AL

Case report
A 50-year-old female patient presented
at our dental office missing both man-
dibular central incisors. The teeth had
suffered from fracture at the gingival
level due to mechanical trauma from
an accident. Both remaining roots had
been extracted by another practitioner
3 months earlier during an unsuccessful
attempt at preservation by endodontic
treatment. The patient now requested Fig 1 The gap was marked by severely compro-
mised red and white esthetics.
the replacement of the teeth. The re-
sulting gap had been provided with an
adhesive bridge characterized by se-
verely compromised white and red es-
thetics (Fig 1). The patient worked as a
teacher and was a non-smoker with an
unremarkable medical history. Intraoral-
ly, several conservative and prosthetic
restorations were present in good con-
dition. The cleansability in the area of
the adhesive bridge was limited due
to the defect configuration, but the pa-
tient’s overall oral hygiene was satisfac-
tory. Her biotype could be described as
rather thick.
Fig 2 Class III defect with a combined horizontal
The clinical examination and radio- and vertical component.
graphic evaluation (Fig 28) revealed
a soft and hard tissue defect in both
the horizontal and vertical dimensions
(Figs 2 and 3). This corresponded to a
class III defect, according to the clas-
sification by Studer et al,19 with a poor
prognosis for a satisfactory esthetic
outcome. A removable partial denture
was not an option for the patient. Based
on these findings, three treatment op-
tions were considered and discussed
with the patient: (1) A permanent adhe-
sive bridge, (2) a conventional bridge
with soft tissue augmentation only, or
(3) an implant-supported solution with Fig 3 Defect formation in the horizontal direction.

207
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT
Fig 4 Two bone plates were used to cover the
defect.
bone and soft tissue augmentation. The
patient decided on the third option. Al-
though a cantilever solution is the au-
thors’ usual approach in such situations,
a solution with two implants was cho-
sen in this special case for two reasons:
First, the patient insisted strongly on a
solution with two implants, although the
possible disadvantages of higher cost,
extended surgical time, and excessive
site development were explained to her.
Second, the patient presented with a
deep covered bite, which would have
resulted in strong masticatory forces on
a potential cantilever. This may have led
to early fatigue and prosthetic complica-
tions due to the increased mechanical
angular moment.20 Based on clinical ex-
perience, and also to lower the patient’s
expectations in advance, we informed
her that reconstruction of the interdental
gingiva would hardly be achievable with
two implants.
The first surgical procedure was car-
ried out in accordance with the cortical
bone plate method for vertical and hori-
zontal ridge augmentation. The surgical
208
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

Fig 5 The plates were secured with an osteosyn-
thesis screw.
site was disinfected with a 0.12% chlor-
hexidine solution, with which the patient
rinsed for 1 min. After the removal of the
adhesive bridge and the administration
of local anesthesia, an alveolar ridge in-
cision in the keratinized tissue and an in-
trasulcular incision at the teeth adjacent
to the gap were performed. The papillae
lateral to the edentulous area were mo-
bilized. A full thickness flap was raised
on the buccolingual side, followed by
periosteal slitting to create a mucoperi-
osteal–mucosal flap for mobilization of
the buccal flap. A cortical bone plate was
harvested from the angle of the mandi-
ble and divided longitudinally with a dia-
mond disc. The two plates were secured
over the defect area with osteosynthesis
screws (Cortex Screw PlusDrive 1.5 mm,
Synthes), providing stable fixation and
adequate coverage of the defect (Figs 4
and 5). The space between the cortical
bone plates and the niches buccal to the
bone plates were filled with a mixture of
particulate autogenous bone harvested
with a bone scraper (Safescraper Twist,
Imtegra), and a deproteinized bovine
 BÄUMER ET AL

bone mineral (Bio-Oss, Geistlich) with

the anticipated overcorrection. A non-
cross-linked collagen membrane (Bio-
Gide, Geistlich) was applied over the
defect, and a subepithelial connective
tissue graft from the lateral palate was
placed to increase the soft tissue volume,
to prevent membrane exposure, and to
ensure closed healing of the augmen-
tation site even if postoperative wound
dehiscence were to occur. For flap clo-
sure, horizontal mattress sutures were Fig 6 The connective tissue gleamed through
due to postoperative swelling and slight flap de-
placed with a nonresorbable suture ma-
hiscence.
terial (Cytoplast PTFE EP 1.5 C3, Osteo-
genics Biomedical) to stabilize the flap
on the alveolar ridge, and double-loop
sutures were placed for primary closure. The donor site on the lateral palate was
The vertical incisions were closed with sutured with horizontal sling sutures to
interrupted sutures, and the mobilized exert pressure on the surgical wound
papillae were closed with vertical mat- in order to promote hemostasis and
tress sutures. Gentle pressure was ap- primary wound healing. Additionally, a
plied to the wound for several minutes wound dressing with a tissue adhesive
to reduce the formation of a blood clot (Histoacryl, Braun) and a periodontal
at the soft tissue graft, as this might pos- dressing (Coe-Pak, GC) were applied.
sibly impede the influx of oxygen and Finally, the patient was given compre-
metabolites by plasmatic circulation hensive postoperative instructions and
during the initial phase of healing.21,22 was advised to take prescribed medi-

Figs 7 and 8 Six months after bone augmentation.

209
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT

cation, including an antibiotic (Aug-

mentin, GlaxoSmithKline), an analgesic
*CVQSPGFO
"DUBWJT
(SBOVMBU
øNH

B

chlorhexidine mouth rinse (GUM Paroex
0.12%), and anti-inflammatory homeo-
pathic substances (Traumeel, Dr. Peith-
ner; Bromelain-POS, Ursapharm).
The provisional restoration was
placed with a self-curing composite
(Clearfil Core New Bond, Kuraray) at the
time of suture removal 1 week later, leav-
Fig 9
5IF
BVHNFOUFE
CPOF
BGUFS

NPOUIT ing space for postoperative swelling in
the first days of healing. At that time, the
wound was slightly open due to swell-
ing, so that the connective tissue graft
gleamed through, but the overall healing
BQQFBSFE
UP
CF
HPPE
'JH



During a second surgical appoint-
NFOU


NPOUIT
MBUFS
UIF
BEIFTJWF
CSJEHF

was again removed (Figs 7 and 8), and
a full-thickness flap was prepared to ac-
cess the augmented bone (Fig 9). The
osteosynthesis screws were removed,
and two implant beds were prepared
with a diameter of 2.75 mm, followed by
the insertion of two 3.25-mm wide and
11.5-mm long parallel walled implants
(Osseotite Certain 2, Biomet 3i). The im-
plants were provided with cover screws
(Figs 10 and 11). An autologous connec-
tive tissue graft was harvested from the
tuberosity on the right side and placed
above the implants. The flap was closed
in a microsurgical manner according to
the procedure previously described,
and a postoperative radiograph was
taken (Fig 27).

Figs 10 and 11
5XP
ø Yø NN
QBSBMMFM

walled implants were placed.

210
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 BÄUMER ET AL

Figs 12 and 13 Four months after implant placement.

After a closed healing time of 4 months The adhesive bridge was cemented
(Figs 12 and 13), the implants were un- again, and vertical double-crossed su-
covered in a tunneling procedure, and UVSFT
4FSBMFOF

%4
"NFSJDBO

an autograft from the left tuberosity was Dental Systems) were placed (Fig 14).
inserted into the created pouch. Before The medication prescribed was identi-
the healing abutments were connected cal to that for the first procedure, and the
.JDSP.JOJ


NN
#JPNFU
J

UIFZ
XFSF
site was healing well at the time of suture
adjusted manually in the dental labora- removal 1 week later (Fig 15).
tory to allow proper fit into the small gap.

Fig 14 Vertical double-crossed sutures after soft Fig 15 Healing 1 week after soft tissue augmen-
tissue augmentation. tation.

211
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT

A month later, the implant impression

was taken and the healing abutments
XFSF
SFDPOOFDUFE
'JHT


UP

BOE

29). After another 2 weeks, long-term
provisional restorations were inserted
on individually fabricated zirconia abut-
ments (Figs 19 and 20) using provisional
cement (TempBond, Kerr) to allow the
peri-implant tissues to develop.

Fig 16 Implant impression was taken 1 month af-

ter soft tissue augmentation.

Figs 17 and 18 The manually adjusted healing abutments were reconnected after the implant impres-
sion.

Figs 19 and 20 Individually fabricated zirconia abutments were placed 2 weeks after impression, and
restored with long-term provisional restorations.

212
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 BÄUMER ET AL

Four months later, the final full-ce-
ramic crowns (Creation CC, Creation
Willi Geller International) were placed,
and another 2 weeks later, and then
another 3 months later, the laboratory
technician performed esthetic refine-



BOE


4IF
XBT
BE-
ments (Figs 21, 22, and 30). Figure 32
shows the scheme of the order of inter-
ventions.
The patient was satisfied regarding
the function and esthetics of the final
result, and returned for a follow-up ap-
pointment 7 months after crown inser-
tion (Figs 23 and 24), and then 8 months
MBUFS
'JHT


vised to come back for yearly follow-ups
in addition to dental hygiene visits at her
referring dentist.

Figs 21 and 22 The final crowns were placed after a 4-month period with long-term provisional restor-
ations.

Figs 23 and 24 Seven months after crown insertion.

213
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT
Figs 25 and 26 Fifteen months after crown insertion.
Discussion
The treatment outcome of the present-
ed patient case was a success in terms
of esthetics, which were very pleasing.
Looking back at the original situation (a
class III defect before treatment), the
actual result could not have been ex-
pected with certainty. A good precondi-
tion for reconstruction was the high bone
level of the neighboring teeth, which was
visible in the initial radiograph. One rea-
son for the success of this case might
be that the applied cortical bone plate
method seems to offer a high recon-
structive potential for vertical defects.
Although scientific investigations show
that the GBR technique, the distraction
technique, and the sandwich technique
can lead to complete defect recon-
struction in both horizontal and vertical
dimensions, clinical experience shows
that, especially between two implants or
two pontics, complete success cannot
be definitely predicted with these treat-
ment techniques. Despite the positive
214
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

clinical results experienced when the
cortical bone plate method is applied,
it is currently not clear from a scientific
point of view how successful it can be
when applied to class III defects on a
regular basis.
A question of special interest in this
context is the long-term prognosis and
volume stability of the augmented tissue
in the vertical dimension. In esthetically
irrelevant areas, resorption processes
can be tolerated to some extent, but
in the anterior zone, exposed implant
components lead to relevant difficulties.
Another important aspect is the tech-
nique sensitivity of all techniques, and
the patient morbidity involved. Consid-
ering these factors, none of the above-
mentioned available augmentation
techniques can be said to be superior
to any other for the routine treatment of
vertical defects. The authors are of the
opinion that Khoury’s cortical bone plate
method is the method of first choice be-
cause the combination of cortical bone
and bone particles appears to imitate
 BÄUMER ET AL

conditions that are most similar to the

natural structure of alveolar bone, which
is composed of cortical and cancellous
bone.23 This, however, has not yet been
sufficiently proven scientifically.

Fig 27 Radiograph after implant placement.

Fig 28 Radiograph of Fig 29 Radiograph

initial defect formation. at implant impression.

Fig 31 Radiograph
Fig 30 Radiograph 15 months after crown
after crown insertion. insertion.

215
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT
Fig 32 Scheme of the order of interventions.
Before choosing the prolonged and
risky reconstructive surgical approach, a
prosthetic solution should always be con-
sidered and discussed with the patient
to evaluate which is best and which the
patient prefers. An alternative solution to
the described approach could be a FPD,
combined with soft tissue augmentation
of the pontic area. This is a feasible op-
tion, especially in the anterior mandible,
and adhesive bridges work well over the
long term. The use of pink ceramics in
unexposed areas can be preferable to
a soft tissue build-up; the precondition
is that the area is not visible when the
patient smiles, and that adequate oral
hygiene measures are still possible.
As an alternative to the chosen ap-
proach, a one-time abutment solution is
worth considering. It has been report-
ed that repeated abutment changes
during prosthetic treatment for implant
impressions and for the delivery of the
final abutments might have a negative
influence on the stability of the peri-
implant bone and the surrounding soft
tissues.24-27 Therefore, connecting the
final abutment as early as possible in the
course of treatment and leaving the epi-
thelial seal untouched may be advanta-
geous because it allows for a reduction
of clinical procedures. The benefits of
216
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

digital fabrication give additional value
to this approach.28 On the other hand,
placing the final abutment at the time
of surgery may be a disadvantage be-
cause it is not possible to predict the
amount of soft tissue shrinkage. In the
presented case, for example, the sur-
geon expected more soft tissue shrink-
age, and multiple soft tissue augmenta-
tions were done, which made the soft
tissue contour even more unpredictable.
Without individualized abutments, there
would have been less control over the
position of the crown margins, which
could have resulted in less access for
the removal of excess cement.29
Another point of discussion regarding
the course of reconstruction is the choice
of the soft tissue graft to be applied. Soft
tissue grafts can be harvested from dif-
ferent areas in the oral cavity: the anter-
ior and posterior lateral palate, and the
maxillary tuberosity. These grafts vary
as regards their geometric shape and
their histologic composition. A graft from
the tuberosity is more voluminous and
appears to contain more dense tissue,
characteristics which might affect its
healing dynamics and long-term stabil-
ity. In contrast, a graft from the anterior
lateral palate appears to be looser, and
contains more fatty and glandular tissue,
 BÄUMER ET AL

due to which it might be less prone to
necrosis when exposed in the event of
flap dehiscence. Although these issues
must be evaluated in scientific studies, a
surgeon may already take them into con-
sideration when choosing the harvesting
site for soft tissue augmentation.21
Conclusion
A general recommendation for the best
treatment modality cannot be given, but
in very difficult cases such as the one
presented here, the treatment option de-
cision also depends on the surgical skills
and experience of the clinician. While
demanding surgical treatment paths
can lead to functionally successful and
esthetically pleasing results, prosthetic
solutions with less surgical involvement
may be a feasible alternative. The po-
tential, as well as the stability, of the
cortical bone plate method for alveolar
ridge construction has to be evaluated
scientifically in long-term observations,
as do the characteristics of the different
soft tissue grafts.

Int J Periodontics Restorative

References

-JOEIF
+
3JEHF
Frei M, Belser UC. Long-
1. Bastone EB, Freer TJ, McNa-
mara JR. Epidemiology of
dental trauma: a review of
the literature. Aust Dent J
2000;45:2–9.
2. Glendor U. Epidemiology
of traumatic dental injuries
– a 12 year review of the
literature. Dent Traumatol
o
3. Pjetursson BE, Brägger
U, Lang NP, Zwahlen M.
Comparison of survival and
complication rates of tooth-
supported fixed dental pros-
theses (FDPs) and implant-
o

supported FDPs and single
crowns (SCs). Clin Oral
Implants Res 2007;18(suppl
3):97–113.
4. Van der Weijden F,
Dell’Acqua F, Slot DE. Alveo-
lar bone dimensional chang-
es of post-extraction sockets
in humans: a systematic
review. J Clin Periodontol
o

5. Schropp L, Wenzel A,
Kostopoulos L, Karring T.
Bone healing and soft tissue
contour changes following
single-tooth extraction: a
clinical and radiographic
12-month prospective study.
Dent 2003;23:313–323.

"SBÞKP
.(
alterations following tooth
extraction with and without
flap elevation: an experi-
mental study in the dog.
Clin Oral Implants Res
2009;20:545–549.
7. Sanz-Sánchez I, Ortiz-Vigón
A, Sanz-Martín I, Figuero
E, Sanz M. Effectiveness of
Lateral Bone Augmentation
on the Alveolar Crest Dimen-
sion: A Systematic Review
and Meta-analysis. J Dent
Res 2015;94(9 suppl):128S–
142S.
8. Esposito M, Maghaireh H,
Grusovin MG, Ziounas I,
Worthington HV. Soft tis-
sue management for den-
tal implants: what are the
most effective techniques?
A Cochrane systematic
review. Eur J Oral Implantol
2012;5:221–238.
9. Pieri F, Aldini NN, Marchetti
C, Corinaldesi G. Esthetic
outcome and tissue sta-
bility of maxillary anterior
single-tooth implants fol-
lowing reconstruction with
mandibular block grafts: a
5-year prospective study. Int
J Oral Maxillofac Implants
2013;28:270–280.
10. Buser D, Chappuis V, Born-
stein MM, Wittneben JG,
term stability of contour
augmentation with early
implant placement following
single tooth extraction in the
esthetic zone: a prospective,
cross-sectional study in 41
patients with a 5- to 9-year
follow-up. J Periodontol
2013;84:1517–1527.
11. Chen ST, Buser D. Esthetic
outcomes following immedi-
ate and early implant place-
ment in the anterior maxilla
– a systematic review. Int
J Oral Maxillofac Implants
 TVQQM
12. Chiapasco M, Romeo E,
Casentini P, Rimondini L.
Alveolar distraction osteo-
genesis vs. vertical guided
bone regeneration for the
correction of vertically
deficient edentulous ridges:
a 1-3-year prospective
study on humans. Clin Oral
Implants Res 2004b;15:82–
95.
13. Simion M, Jovanovic SA,
Tinti C, Benfenati SP. Long-
term evaluation of osseoin-
tegrated implants inserted
at the time or after verti-
cal ridge augmentation. A
retrospective study on 123

217
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

 CASE REPORT
implants with 1-5 year follow-
up. Clin Oral Implants Res
2001;12:35–45.
14. Chiapasco M, Zaniboni M,
Rimondini L. Autogenous
onlay bone grafts vs. alveo-
lar distraction osteogenesis
for the correction of vertically
deficient edentulous ridges:
a 2-4-year prospective
study on humans. Clin Oral
Implants Res 2007;18:432–
440.
15. Nyström E, Ahlqvist J,
Gunne J, Kahnberg KE.
10-year follow-up of onlay
bone grafts and implants in
severely resorbed maxillae.
Int J Oral Maxillofac Surg
o

+FOTFO
05
"MWFPMBS
TFH-
mental “sandwich” osteoto-
mies for posterior edentulous
mandibular sites for dental
implants. J Oral Maxillofac
4VSH
o
17. Jensen OT, Cockrell R,
Kuhike L, Reed C. Anterior
maxillary alveolar distraction
osteogenesis: a prospec-
tive 5-year clinical study. Int
J Oral Maxillofac Implants
o
18. Chiapasco M, Consolo U,
Bianchi A, Ronchi P. Alveolar
distraction osteogenesis for
the correction of vertically
deficient edentulous ridges:
a multicenter prospec-
tive study on humans. Int
J Oral Maxillofac Implants
2004a;19:399–407.
19. Studer S, Naef R, Schärer
P. Adjustment of localized
alveolar ridge defects by
soft tissue transplantation
to improve mucogingival

(VB[[J
1

4BNB-
esthetics: a proposal for
clinical classification and
an evaluation of proced-
ures. Quintessence Int
1997;28:785–805.
218
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
46..&3

20. Stanford C, Cooper L. Role implants: a 1-year follow-up
of Implant-Implant and Tooth- of a multicentre randomised
Implant Supported Fixed controlled trial. Eur J Oral
Partial Dentures. In: Lindhe Implantol 2014;7:141–149.
J, Lang NP (eds). Clinical 27. Luongo G, Bressan E, Gru-
Periodontology and Implant sovin MG, et al. Do repeated
Dentistry. Wiley Blackwell, changes of abutments have
2015. any influence on the stability
21. Zuhr O, Bäumer D, Hürzeler of peri-implant tissues? Four-
M. The addition of soft tissue month post-loading prelimi-
replacement grafts in plastic nary results from a multicen-
periodontal and implant tre randomised controlled
surgery: critical elements in trial. Eur J Oral Implantol
design and execution. J Clin 2015;8:129–140.
Periodontol 2014;41(suppl 28. Beuer F, Groesser J, Sch-
15):S123–S142. weiger J, Hey J, Güth JF,
22. Guiha R, el Khodeiry S, Mota Stimmelmayr M. The Digital
L, Caffesse R. Histological One-Abutment/One-Time
evaluation of healing and Concept. A Clinical Report.
revascularization of the J Prosthodont 2015 [epub
subepithelial connective ahead of print 5 Jan 2015].
tissue graft. J Periodontol EPJKPQS
2001;72:470–478. 29. Piñeyro A, Tucker LM. One
23. Khoury F, Antoun A, Missika abutment-one time: the neg-
P. Bone Augmentation in Oral ative effect of uncontrolled
Implantology. Berlin, London: abutment margin depths
Quintessenz, 2007. and excess cement – a case
24. Degidi M, Nardi D, Piattelli A. report. Compend Contin
One abutment at one time: &EVD
%FOU
o
non-removal of an immedi-
ate abutment and its effect
on bone healing around
subcrestal tapered implants.
Clin Oral Implants Res
2011;22:1303–1307.
25. Grandi T, Guazzi P, Sama-
rani R, Garuti G. Immedi-
ate positioning of definitive
abutments versus repeated
abutment replacements in
immediately loaded implants:
effects on bone healing
at the 1-year follow-up of
a multicentre randomised
controlled trial. Eur J Oral
*NQMBOUPM
o

(SBOEJ
5
rani R, Maghaireh H, Grandi
G. One abutment-one
time versus a provisional
abutment in immediately
loaded post-extractive single