Managing Anterior Implant Esthetics: Technique for Immediate Placement

A 37-year-old male patient presented with a fractured crown on tooth No. 9, which had been previously treated and restored with a zirconia crown. Clinical examination revealed that the crown had broken at the gingival level, and a ferrule effect could not be achieved without compromising esthetics. Radiographic evaluations confirmed sufficient bone levels for implant placement. The tooth was atraumatically extracted, preserving the buccal bone wall. A 4.2 mm x 12 mm tapered implant with a 3.5 mm platform was placed with an initial torque of 40 Ncm. To facilitate implant success and preserve esthetics, a temporary cylinder was used to maintain the emergence profile, and Duo-Link Universal^™ (BISCO, bisco.com) adhesive resin cement was applied to secure the cylinder. The cylinder was relined with composite, and a temporary crown was fabricated. For stabilization, a ribbon was bonded from teeth Nos. 7 and 8 to tooth No. 10 using 37% phosphoric acid, All-Bond Universal^® (BISCO), Z-Prime^™ Plus (BISCO), and A2 composite. After 4 months, the implant integrated successfully, with the papillae and emergence profile preserved. Digital impressions were taken with an intraoral scanner (Trios^®, 3Shape), and a zirconia crown (Katana^™ Zirconia, Kuraray) was fabricated and cemented with Thera­Cem^® (BISCO). The final restoration achieved excellent esthetics and a functional outcome.

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OMNICHROMA Flow BULK, a one-shade bulk fill composite, shade-matches any tooth color from A1 to D4. A low viscosity, light-cured material, placed in 3.5mm increments.