background image
90 TheJournalofCosmeticDentistry·Winter2006
Volume21·Number4
and that an immediate implant
with provisional would be the best
option to maintainthe case. For the
emergency appointment, the frac-
tured segment was bonded on using
Panavia21 (Kuraray;NewYork,NY)
and the patient was scheduled for
evaluation by an oral surgeon.
The treatment plan would in-
volve extraction of fractured tooth
#8, implant placement, and use
of the patient's own crown as the
provisional. A surgical guide and
matrix were fabricated in the event
they were needed. The surgical
procedure was the same as that in
Case 1. A 4.3-mm x 16-mm Nobel
Perfect scalloped implant, filled with
platelet-rich plasma, was placed into
the socket.
Great care must be used to ensure
that all residual cement is removed
to avoid an iatrogenic tissue
reaction.
P
rovIsIonAl
r
estorAtIon
Care was taken during surgery to
section the crown from the residual
root for later use as a provisional. Af-
ter surgery, an abutment was placed
and existing hollow ground crown
was approximated using a self-cure
composite. Due to margin depth of
approximately 2.5 mm, moisture,
and residual platelet-rich plasma,
the margin was not well captured,
but the relationship to the adjacent
teeth and abutment body was ac-
curate. The abutment was then re-
moved from the implant and placed
on a brass analog. The margins and
emergence profile of the provisional
were refined extraorally (Fig 9). A
microhybrid composite was used
(Four Seasons, Ivoclar Vivadent),
due to its strength and polishability.
The provisional restoration was
checked to ensure that there was no
contact in centric occlusion or any
C
liniCal
S
CienCe
e
rlaCh
/J
arviS
Figure 9: Adapting margins of provisional.
Figure 10: Provisional in place one week after surgery.
Figure 11: Before surgery.
Figure 12: Two months after cementation.