JCDA - Canadian Dental Association

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682 November 2003, Vol. 69, No. 10 SIMPLIFY YOUR PAYROLL RELIABLE, ACCURATE and RESPONSIVE Call: 1-877-316-2999 JCDA Online Subscriptions Subscription renewals: JCDA subscribers can now renew their subscriptions online at cdaadc.ca/jcda/subscribe. New subscriptions: Those who currently do not receive JCDA can also subscribe to the journal online through CDA’s Web site. Journal of the Canadian Dental Association
Clinical Showcase Clinical Showcase is a series of pictorial essays that focus on the technical art of clinical dentistry. This new section features stepby-step case demonstrations of clinical problems encountered in dental practice. If you would like to propose a case or recommend a clinician would could contribute to Clinical Showcase, contact editor-in-chief Dr. John O’Keefe at jokeefe@cda-adc.ca. Single-Tooth Implant Reconstruction in the Anterior Maxilla Morley S. Rubinoff, DDS, Cert Prosth Everyone wants to “get into implants.” “Just start with single teeth,” they say. “Just screw in a post and slap on a crown, it’s that simple.” In truth, fabricating an implant crown in the esthetic zone can be a nightmare. Colour matching, hard and soft tissue management, concerns about root proximity, occlusal considerations such as a deep overbite or parafunctional habits are just some of the challenges practitioners face when preparing an implant in the anterior maxilla. This article discusses 2 important prosthodontic issues relating to the placement of dental implants in the esthetic zone. Tissue management is paramount in achieving a good esthetic result when restoring the single-tooth implant. Tissue “training” helps to develop a proper emergence profile and natural tooth appearance. Far too frequently, dentists do not fabricate provisional crowns before insertion of the final prosthesis, which may result in compromised esthetics. As to the question of whether to choose a screw-retained restoration or a cement-retained restoration, 1 Journal of the Canadian Dental Association 2 soft-tissue position and occlusal considerations will often influence this decision. Patient Presentation Our patient was a 39-year-old woman with a noncontributory medical history. She had a fractured post–core on a nonrestorable abutment (tooth 21), where endodontic treatment had failed. No buccal plate of bone was present due to pathologic changes. The surgical phase of treatment included extraction, debridement and bone augmentation using bovine bone (Bio-Oss, OsteoHealth Co., Shirley, N.Y.) and a barrier membrane (Cytoplast Regentex TXT-200, Osteogenic Biomedical, Lubbock, Texas). An implant (Straumann ITI implant, Institut Straumann AG, Villeret, Switzerland) measuring 4.1 mm in diameter × 12 mm in height with an Esthetic Plus collar measuring 1.8 mm in height was surgically placed. The patient wore a partial denture (flipper) during the 6-month healing period. Soft-Tissue Management The crestal bone surrounding the dental implant must remain at the same level as the adjacent bone of the natural teeth after implant surgery. Soft tissues will collapse around the transmucosal healing collar. Tissue “training” with a provisional crown helps to re-establish normal gingival tissue contours and interdental papillae and to achieve adequate tooth emergence. The final impression must capture the “trained” soft tissue for successful restoration in the dental lab. Figures 1 to 3: Preoperative radiograph of apical lesion (Fig. 1). Surgical treatment included placement of a Straumann ITI implant (Fig. 2). Six months after surgery (Fig. 3), tissues appear collapsed around the healing collar. 3 November 2003, Vol. 69, No. 10 683
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JCDA Journal of the Canadian Dental
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CONTENTS Journal of the Canadian De
Page 7 and 8:
Editorial EXPERIMENT AND INNOVATE O
Page 9 and 10:
President’s Column PLANNING FOR T
Page 11 and 12: denturists, assistants and dental t
Page 13 and 14: Letters Editor’s Comment The Jour
Page 15 and 16: NEW! White Teeth, Fresh Breath. A G
Page 17 and 18: News NIHB Dental Faxback Confirmati
Page 19 and 20: that most dentists are interested i
Page 21 and 22: Post-Operative Nausea and Vomiting
Page 23 and 24: CDA: Year in Review C O N T E N T S
Page 25 and 26: ITRANS — a uniquely secure, Inter
Page 27 and 28: CDA: Working with Industry CDA cont
Page 29 and 30: The oral health of Canadians and th
Page 31 and 32: Introducing … Dr. Jack Cottrell V
Page 33 and 34: CDA 2003 Award Winners Leading ligh
Page 35 and 36: CDA Down Under Two presidents meet
Page 37 and 38: If You’re Recovering Recovering f
Page 39 and 40: The high prevalence of dentin hyper
Page 41 and 42: Guideline for Treatment of acute ap
Page 43 and 44: Long-term pain management tool? NEW
Page 46: Background Light-emitting diode (LE
Page 49 and 50: THERE’S NO SUBSTITUTE FOR PROPER
Page 51 and 52: Aurum Ceramic /Classic - Aesthetics
Page 53 and 54: 1 Background Traumatic injuries to
Page 55 and 56: 5 Background Although there have be
Page 57 and 58: Point of Care The Point of Care sec
Page 59 and 60: Figure 1: Panoramic radiograph reve
Page 61: film of tissue fixative (95% ethano
Page 65 and 66: Journal of the Canadian Dental Asso
Page 67 and 68: What do you do when an independent
Page 69 and 70: The Canadian Dental Association (CD
Page 71 and 72: Classified Ads Guaranteed access to
Page 73 and 74: make a good income. Please call col
Page 75 and 76: caring, dynamic, with excellent cli
Page 77 and 78: Use in Children: Clinical experienc
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JCDA - Canadian Dental Association

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