Two Stage Implant Placement for a Failing Central Incisor with Ankylosis to Labial Bone Plate.

A 45-year-old female patient who was referred re-failing post crown in tooth #21 FDI (#9 US), multiple failed veneers, generalised tooth wear and loss of Occlusal Vertical Dimension (OVD). She was medically fit with No Relevant Medical Health (NRMH). In her dental diagnosis she presents generalised tooth wear and failing maxillary anterior restorations with multiple teeth needing restoration.

The treatment selected for the replacement of the central incisor involved the extraction of the root of #21 FDI (#9 US) initially hoping to carry out immediate implant placement, however ankylosis to labial bone plate necessitated delayed approach. The late-delayed two-stage implant (NobelActive®) was placed at 8 weeks with simultaneous Guided Bone Regeneration (GBR). On a second stage surgery at approximately 4 months with simultaneous soft tissue augmentation with a Connective Tissue (CT) graft was needed.

The prosthetic treatment selected for its first provisional was a Rochette fixed partial denture. Once the implant was placed, its provisional was made on a NobelProcera® Abutment Zirconia MZ and the final restoration was an IPS e.max® Lithium Disilicate crown on the zirconia abutment, along with the restoration of numerous upper and lower teeth.