PAGD Keystone Explorer Summer 2020

12 www.pagd.org Q dentistry issues When a patient present with fractured teeth in the esthetic zone, a case can quickly become challenging and that is exactly what is presented here. A male patient in his late thirties presented to the office with both his left central incisor and left lateral incisor fractured. Figure 1 A brief history from the patient revealed that these teeth were previously crowned and had been splinted together. The patient’s occlusion also would present a problem as there are signs of cross over wear by the angled right central incisor and there is an anterior crossbite at the right lateral incisor. A radiograph is presented for completeness and for analysis of the depth of the fracture in relationship to the bone. Figure 2 After a thorough discussion of the treatment options and a brief history on the limits of the manipulation of the soft and hard tissues in combination with implant therapy the patient chose to have tooth #9 restored conservatively with a core buildup and crown with minor soft tissue crown lengthening and tooth #10 to be extracted and an implant placed. An immediate implant was placed at the time of extraction. Figure 3 The area was temporized with the patients previous FPD and it was immediately noticeable that there was a gingival discrepancy post surgery. Figure 4 Following a healing period of eight weeks, the implant was uncovered and provisionalized. Tooth #9 was also crown lengthened and temporized at this time. Figure 5 A laser was used to complete the crown lengthening and expose the margins My PEAK Presentation Esthetic Dilemma Raymond Johnson, DMD, MAGD Figure 1 Figure 2 Figure 4 Figure 3