Caroliene Meijndert

103 Immediate placement and restoration of a new tapered implant system in the aesthetic region a b c Figure 1. Initial situation before treatment of one of the included patients. Note the intact facial bone wall, having at least a thickness of 1 mm in the cervical region. Surgical procedure Patients started prophylactic antibiotic treatment one day before the surgery (Amoxicillin 500 mg, three times daily for 7 days) and twice a day a 0.2% chlorhexidine mouth rinse (Corsodyl; GlaxoSmithKline, Utrecht, the Netherlands). After administering local anaesthesia (Ultracaine D-S Forte; Aventis Pharma Deutschland GmbH, Frankfurt amMain, Germany), the periodontal fibers were separated from the tooth after which the affected tooth could be carefully removed without raising a flap. The alveolus was carefully inspected and cleaned of residual granulation tissue. The manufacturers drilling protocol was followed starting with the needle drill marking site of implant insertion as dictated by the (semi-guided) drilling template ( Figure 2a ). The surgeon ensured that the implant was positioned slightly palatal to the axis of the original root, for sufficient initial stability and ensuring a buccal bone thickness of at least 2 mm in the cervical region. The final implant drill was placed in the osteotomy as a space maintainer during augmentation of the gap between the drill and buccal wall. A 1:1 mixture of autologous bone (residual bone chips collected from the burs during osteotomy) and anorganic bovine bone (Geistlich Bio-Oss®, Geistlich Pharma AG) was used ( Figure 2b ). Next, the final drill was carefully removed and the implant (Straumann BLX implant, Strauman AG, Basel, Switzerland ( Figure. 3 )) was placed 3 mm apical to the most apical aspect of the prospective clinical crown. The implant was torqued to 45 Ncm. An implant- level open tray impression was made with a vinylpolysiloxane precision impression material (Provil Novo, Medium fast set. Kulzer Mitsui Chemical Group, Germany). The impression was sent to the dental lab for manufacturing the provisional restoration. A healing abutment was placed on the implant. A sterile re-absorbable gelatin sponge haemostat (Cutanplast®, Mascia Brunelli, Milan, Italy) was applied to seal the graft 6