This case is an excellent demonstration of the use of the minimally invasive access flap technique for treatment of (chronic) periodontitis in an esthetically critical zone. The access flap was used in conjunction with enamel matrix proteins for regenerative therapy.,

Gliederung: - Chirurgische Maßnahmen für die Verankerung einer Planungsschablone - Inserieren von vier provisorischen Implantaten - Abformung und Bissnahme, Herstellung des Meistermodells - Zahnaufstellung für die Interimsprothese - Speicherung der Zahnaufstellung in einem Silikonschlüssel - Kopie der Zahnaufstellung in röntgensichtbarem Kunststoff für die CT-Aufnahmen - Implantatplanung mit Hilfe eines 3D-Datensatzes aus der CT-Aufnahme - Herstellung einer Übertragungsschablone mit dem CAMLOG® Guide System auf Basis der CAD-Planung - Einfügen der Führungshülsen in die Schablone - Anfertigung der definitiven Versorgung vor dem Inserieren der Implantate - Verwendung Vario SR Abutments mit Vario SR Titankappen für die Erzeugung eines Passive Fit - Herstellung eines gegossenen Gerüstes aus Titan zur Verstärkung der Versorgung - Chirurgische Maßnahmen für die definitive Implantation - Inserieren von sechs Implantaten zur Sofortbelastung - Gezielte Erzeugung eines Passungsspiels zwischen Implantat und Prothesenbasis

Objectives: Tooth agenesis is one of the most prevalent congenital craniofacial disorders. The term oligodontia is generally used for agenesis of six or more teeth, and it can be related to a syndrome or present as an isolated condition. The prevalence in permanent dentition is 0.14%. This article reports a case of oral rehabilitation using implants and hard tissue regeneration in a patient with agenesis of 15 permanent teeth and following orthodontics. Methods: A 23-year-old Caucasian man, was referred to the Department of Periodontology and Oral Implantology at Ghent University Hospital. His chief complaints were functional and aesthetic, related to oligodontia. Orthodontic treatment was initiated at the age of 15 in preparation for future implant placement. In addition, the upper third molars were transplanted to positions 35 and 45. After orthodontic treatment, a cone beam computerised tomography (CBCT) scan was taken for surgical treatment planning, including implant placement. Concave and knifed-edged bone in the upper jaw and the limited bone quality and quantity of the lower jaw indicated the need for bone augmentation. The materials selected were seven Astra EVä/® implants, and Bio-Ossä/® and Bio-Guideä/® for the hard tissue regeneration. Second-stage surgery for the low bone quality and hard tissue regeneration was scheduled for 6 months after placement. Two weeks after this minimally invasive surgery, prosthodontic therapy was initiated. Open-tray impressions were made to manufacture provisional, screw-retained crowns. The shape of the provisional restorations was adjusted by adding composite, putting pressure on the mucosa and optimising the pink aesthetics. Results: The treatment included orthodontic therapy, tooth transplantation, a fixed partial denture in the anterior mandible and seven single implants. Implant placement was via flap surgery and simultaneous guided bone regeneration (GBR) in the upper jaw. Reduced height, width and quality of alveolar bone are common in patients with congenitally missing teeth are; to deal with this, and to restore the buccal contour, GBR was deemed necessary. Implants were covered after 6 months and provisional restorations were made on teeth and implants. The patients is currently functioning with the provisional restorations, which have had a profound impact on his self-esteem. Permanent restorations will be placed after another 6 months. To date, the buccal contour of the implant sites has shown limited resorption. Conclusions: Treatment of oligodontia patients with dental implants is challenging because of the reduced height, width and quality of alveolar bone. This report demonstrated that a proper multidisciplinary treatment plan offers a predictable solution for complex cases. The choice of biomaterials significantly impacts on the final aesthetic outcome.