Fixed Rehabilitation of Two Non-Symmetrical Adjacent Teeth with One Implant

Case Report: A 46-year-old female patient went to our clinic with the absence of some teeth, showing interest in a fixed implant rehabilitation of the left central and lateral incisors. We decided to place one implant with a platform-switched morse-taper connection (IDCam 4,2 x 12 mm, IDI®) in the central incisor position with a screw-retained cantilevered restoration. Flap design included papillae-sparing incisions. Contour augmentation with guided bone regeneration was performed simultaneously to implant placement to correct the fenestration and for aesthetic purposes. After 3 months of osseointegration, second surgical stage was performed and provisionals were fabricated. Then there was a soft tissue modeling period through the necessary changes to temporary crowns. One month after the placement of the provisionals, we noticed that there was a groove on the papilla because of the crestal incision for the implant placement. Our option to solve that was to perform a plasty of the papilla with a diamond bur. The purpose was to deepithelize the area to promote new healing of the soft tissue. After 6 months, final impression was made and a screw-retained metal-ceramic restoration was fabricated. Discussion: Rehabilitation of two adjacent teeth with implants in the aesthetic zone is always a challenge, particularly in the same quadrant due to its assymetry. According to several authors, the placement of only one implant with two crowns can be advantageous, since it is likely to have more soft tissue height between one implant and one pontic than between two implants, where only 3.4 mm of tissue height is expectable on average,. The type of connection as well as the platform-switched abutment used in this case may also be beneficial since it may preserve more bone at the crestal level and thus contribute to better support of the soft tissue. Conclusion: The described procedure was successful in terms of function and esthetics, returning the patient's confidence in her smile. Keywords: implants, adjacent teeth, cantilever, papilla, esthetics