01  Patient basic information

Main situation：

Age: 22，

Gender: male，

Upper anterior teethcongenital absence，

requested to planting restoration.

Present：After orthodontic treatment,12 and 22 were missed.

History:didn't have medical history of systemic diseases,no smoking and grinding teeth habit,has had orthodontic treatment,and now wearing retainer.

02  Preoperative examination

Extraoral examination

The patient's expression was common but the right and left face was slightly asymmetrical，maxillofacial soft issues didn't have obvious unusual.

Intraoral examination

Teeth of 12、13、22、23 Congenital deficiency

The patient missing teeth gap is a bit wide，the lip was slightly collapsed，It's normal that exposure of the reset jaw section.

     MRI checking

Bone width is slightly lack ,approximately 4.0mm，bone height is about 15mm, didn't observed that nearby teeth had significant abnormalities.

03 Treatment plan

The patient's preferred treatment plan: implant restoration,moderate aesthetic requirements.

Plan A：Suggested to Orthodontics to adjust the gap of the teeth to improve the occlusion then implant teeth12,22.

Plan B：Teeth 14,24 veneer repair,12.22 implant restoration

Patient didn't accept orthodontic again, so chose plan B

Intraoral scan by Yilink chairside system

Smile aesthetic was designed by digital software

Change the 2D into a 3D, design the aesthetic effect of 13-23, and print out the model

Show in the mouth

According to the final aesthetic effect to design Yilink chairside system planting guide plate

According to the implant position, design wings as temporary teeth crown

15 minutes quick printing of planting guide plate

Chairside system quick print as temporary teeth crown

04 Surgery

preparation:

Introduce the treatment plan and the cost,signed the informed consent for surgery to patient.

Routine disinfection and local anesthesia.

The implant guide plate was try on in the mouth,good adaption.

Surgical discussion：

Full guide plate guided implantation + lingual PGBR + labial connective tissue transplantation 

In the order of drilling.

Operation producer:

Guide preparation and after the preparation of the pioneer drill,removed guide,insert the guide rod. After the cavity preparation is completed, the probe probes the labial bone wall intact,then implants the thing,the direction is good.

12 teeth torque 25Ncm, 22 teeth torque 35Ncm,set temporary abutment and put the preformed resin crown in the mouth to Pick-Up. 

White arrows indicate black triangles,reason analysis：

1. Because it is not immediate implantation,so the soft tissue at the gums nipple is already flat, and the morphology of the gums nipple is poor after suturing.

2. The position of the gums margin (yellow tip) is more ideal than the gums margin, and the bulge of the key area of the temporary restoration neck causes tension.

Improvement: first design the key area of the temporary restoration at the root of  the crown,ensure the gingival papilla heals well and then shape later.

Wear the temporary restoration body front view 

Jaw view had showed that good condition of fullness in 12,22 areas the temporary restoration body connected good

Teeth 12,22 no occlusal contact between median and anterior movements

Preoperative and postoperative comparison, 22 root lip:

12 teeth:

22 teeth:

Possible cause of deviation: large cortical bone resistance on the palatal side, causing the drill needle inclined towards the side of lips

Suture removal after operation 10 days ,the soft tissue at the gum papilla improved compared with the surgery

Suture removal after operation 10 days, The lip mattress suture was retained, and removed the mold to make the retainer after operation 10 days.

05 Summary

   High smile level patient ,through the digital positive aesthetic design, we guide the digital aesthetic teeth, design the implant position after the aesthetic display in the mouth, and implant the implant under the guidance of the whole process to obtain the expected aesthetic and functional effects. Immediately repair not only satisfied the patient's postoperative aesthetic and pronunciation requirements after surgery, but also use the temporary repair to made the growth of a natural gums contour of the soft tissue around the implant. Correct temporary crown appearance protrusion can promote gums blood circulation, provide good support for the soft tissue around the implant, and also shaped a good soft tissue morphology for the later permanent repair.

06 Product recommendation

   The case used a high precision and stability of the large panel efficient production —— YL-Rearlmaker MIX 3D printer, the imported DLP light curing fast shaping technology, large size printing flat 144 * 81mm, a typesetting four jaw, the fastest printing speed 100mm / hour, greatly improve the customer production effect, and support printing repair model, planting model, planting plate, invisible orthodontic, wax printing, temporary teeth, etc., meet more digital dental application scenarios.