Female patient *1965, by Zembic (2008-2009). The patient asked for a straightforward therapy to replace her failing upper jaw restorations and to improve her overall esthetic situation. She absolutely denied a removable option.

Objectives: Surgical treatment of periodontal disease requires tight closure of the surgical wound, but suturing carries the risks of infection, wound opening and scarring. Chitosan membranes with added indocyanine green (ICG) offer an alternative to suture materials and barrier membranes. The aim of the study was to assess the usefulness of ICG–chitosan membrane for the closure of surgical wounds and as a substitute for membranes for guided tissue regeneration. Methods: In this in vitro experiment, we studied 50 extracted human teeth, 30 samples of porcine gingiva and 10 samples of porcine oral mucosa. We produced chitosan–ICG membranes of 5 x 7mm and welded them with a diode laser to the gingiva, oral mucosa and surface of the tooth roots. Histological analysis was used to identify thermal damage. A rise in temperature on the surface of each sample during welding was determined from temperature profiles recorded with ThermaCAM P45TM thermal camera. The strength of linkages of the ICG membrane with the tissues were measured with a universal tearing machine (Instron 4301TM). We used parametric t-tests, ANOVA and the least significant difference (LSD) post-hoc test to analyse mean maximum temperatures and forces required to rupture linkages in the different tissue types (using s statistical significancelevel of Results: Laser welding of chitosan–ICG membrane to the gingiva, mucosa and root surface was successful and no samples showed significant thermal damage The maximum temperature measured on the root surface during welding was 42.6 ± 9.5° C, which was significantly lower than that for the gums at the already welded membrane on the tooth (55.2 ± 8.0° C) (p = 0.005). Tear forces in three groups of laser-welded gingiva and oral mucosa were 0.14 ± 0.05 N for gingival epithelial welding, 0.06 ± 0.01 N for gingiva welding to connective tissue, and 0.06 ± 0.02 N for oral mucosa welding. Tear forces in four groups of membranes laser-welded to the root surface were 1.41 ± 0.14 N for samples at an angle of 0°, 0.89 ± 0.15 N at 30°, 0.80 ± 0.14 N at 60° and 0.52 ± 0.16 N at 90°. It was 0.85 ± 0.18 N for gingiva welded to the root surface. Conclusion: Within the limits of this study, laser welding of oral mucosa and gingiva can complement the closure of mucosal and periodontal wounds, but cannot replace suturing. The favourable tensile strength of chitosan–ICG membrane linkages with root surface and chitosan’s properties in the membrane is promising as a replacement of non-resorbable membranes. Laser welding of gingiva to the root surface may add further stability to closure of the wound.

Outline: - Patient presentation - Preparing the implant bed, implant placement, checking implant positions - Securing the insertion posts to the index for fabrication of the cast - Suturing details - Delivery of the adapted long-term provisional - Fabricating the cast and the gingival mask, transferring the pontic emergence profiles to the gingival mask, mask adaptation - The master cast under the strip scanner with scan bodies on the laboratory analogs - CAD crown design and virtual anatomic shaping - CAM fabrication of a zirconia abutment - Adhesively connecting the zirconia abutment to the titanium base - Reentry, split-thickness flap, vestibuloplasty, connecting the zirconia abutments to the implants - Mucosal graft to restore a soft-tissue defect - Intraoral impression of the abutments - Fabricating the definitive lithium disilicate crowns: virtual crown design; CAM milling, characterization of the crowns - Delivery, final adjustments, presentation of the treatment outcome