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Volume21·Number4
Winter2006·TheJournalofCosmeticDentistry 91
excursions. Adjustments were pol-
ished and the provisional cemented
with a small amount of provisional
cement (TempBond,Kerr). The pa-
tient was then dismissed with in-
structions not to bite on the front
teeth and return for evaluation in
one week(Fig10).
The postoperative period was
generally uneventful. The provi-
sional had to be recemented after
two months; then, two months after
that, we proceeded with an impres-
sion for final restoration as in Case
1. In this case, a porcelain-fused-to-
metal (PFM) crownwas selected as
the small size of the abutment al-
lows for ample space for porcelain
to achieve required esthetics. To best
communicate the desired shade and
surface texture,the patient's original
crown was sent to the laboratory.
The laboratory fabricated a PFM
crown onto a metal abutment. On
insertion,we were pleased with tis-
sue support color and contour and
no adjustments were required. The
patient was anesthetized and the
crown cemented with RelyX. An-
esthesia is advised due to the deep
margins in the Nobel Perfect im-
plant system. Great care must be
used to ensure that all residual ce-
ment is removed to avoid an iatro-
genic tissue reaction. The patient was
dismissed and seen three weeks after
surgery for a routine hygiene visit
and to take photographs. Preopera-
tive and post operative photographs
show a very successful outcome
(Figs11&12).
c
Ase
3
This patient had had PFM crowns
replaced four years earlier due to
poor marginal fit, causing gingival
inflammation. She went almost a
year with laboratory-fabricate dpro-
visionals (Sinfony;3MESPE).Dur-
ing that time, she had periodontal
C
liniCal
S
CienCe
e
rlaCh
/J
arviS
Figure 13: Before surgery, with gutta percha through
perulis.
Figure 14: Before surgery; shows perulis, #8.
Figure 15: Crown removed for later use as
provisional.
Figure 16: Sectioning of residual root.