and 4 other(s)
-Background: Most patients undergoing implant treatment expect their final restorations to be the same as natural teeth. For esthetic restoration in anterior teeth, the timing and location of implant placement should be carefully determined taking into account bone and soft tissue conditions before surgery. In recent years, computer guided surgery has been developed to help clinicians make implant placement easier. -Aim/Hypothesis: This case report aimed to show two cases that achieve esthetic restoration through the implant placement using 3-D computer guided surgery, transgingival guided bone regeneration(GBR) and immediate provisional restoration in anterior teeth. -Materials and Methods: Two patients had root fracture of the maxillary central incisors. Customized surgical stent was constructed based on the analysis of CT images before surgery. Extraction of maxillary central incisors were performed as carefully as possible without damage to the alveolar bone and immediately implants were placed with customized surgical stent. Alveolar ridge defect around the implants were augmented by the guided bone regeneration with xenograft material (Bio-Oss, Geistlich) and resorbable collagen membrane (Bio-Gide, Geistlich). To avoid aesthetic failure in gingival papillary area, immediate fixed provisional restorations were applied to each implant. The final prostheses were delivered after 6 months of temporary restoration modification. -Results: After 1 year, esthetic and stable results were obtained. The implants placed in the proper position gave a natural soft tissue appearance, and the prosthesis was restored similarly to the natural teeth. Patients were very satisfied with the outcomes of the implant treatment. -Conclusion and Clinical implications: Since extraction is always accompanied by buccal bone resorption, a treatment plan should be prepared to compensate for buccal bone resorption. If the implant surgery is being considered in anterior area, treatment sequence and timing should be determined before extraction for achieving esthetics. Computer guided surgery can be used for accurate 3D positioning of the implant in maxillary esthetic zone, and transgingival GBR and immediate provisionalization can be used to enhance esthetics.
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