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Optimising lateral incisor function and aesthetics with the Hahn Tapered Implant System

The Hahn Tapered Implant was threaded into the undersized osteotomy. (Photograph: Glidewell Laboratories)
Dr. Timothy F.  Kosinski, USA

Dr. Timothy F. Kosinski, USA

Wed. 23. March 2016

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Maxillary lateral incisor agenesis (MLIA) is a congenital condition in which at least one of the maxillary lateral incisors is missing in the primary or permanent dentition. MLIA occurs in the smile zone and affects aesthetics and function.[1,2] Although MLIA may present challenges because of limited space, implant therapy has become one of the primary options for addressing it.[3]

For patients with MLIA, implant therapy is a conservative approach that avoids damage to the neighbouring dentition.[1] Treatment is relatively non-invasive because adjacent teeth do not need to be prepared. If there is not enough room for an implant, it is possible to create space through orthodontic treatment. [4]

The following case summary demonstrates implant placement in a 20-year-old female who presented with an acid-etched bridge used to restore her missing maxillary right lateral incisor. Although aesthetic, the bridge fell off periodically. Because of problems with long-term retention, the acid-etched bridge is not considered a viable permanent solution.[5]

The patient desired implant treatment. The Hahn Tapered Implant System (Glidewell Laboratories) was utilised to restore the missing tooth. A cement-retained BruxZir Anterior crown (Glidewell Laboratories) provided a strong, aesthetic final result.
 

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Case summary
The patient presented with a canine and central incisor that had been minimally prepared to support an acid-etched bridge. The bridge was aesthetic, but the patient was concerned about long-term function (Fig. 1).

The lateral incisor site can present difficulties when surgically placing dental implants. Radiography indicated, however, that there was sufficient space for an implant. Scans were taken using the PaX-i3D Green imaging system (VATECH America).

Because the patient’s anatomy did not present any complications, the implant was placed free-hand. The diameter of the osteotomy was slightly smaller than that of the implant chosen for this case, and a depth of approximately 13 mm was established.

A 3 mm diameter Hahn Tapered Implant was utilised. The diameter size and tapered body of the implant was ideal for the limited space. The implant features prominent threads, which eases placement and allows the clinician to thread the implant into an undersized osteotomy. The ability to place an implant in a slightly smaller osteotomy can help ensure excellent primary stability.[6]

A cover screw was hand tightened into the implant. The patient’s acid-etched bridge was cemented back on to the adjacent teeth and functioned as a transitional appliance during healing. Four months after surgery, the patient returned to begin the restorative process (Fig. 11). A tissue punch was utilised to access the healed implant site.

Panasil polyvinyl siloxane material (Kettenbach) was used to create a final impression. The dental laboratory fabricated an Inclusive Custom Implant Abutment in titanium (Glidewell Laboratories) and a BruxZir Anterior crown. Because the patient could only return to the dental office during school holidays, she again wore the bridge as a transitional prosthesis.

At the final delivery appointment, the custom implant abutment was placed and the final crown was cemented on to the abutment. The patient was pleased to have a fixed restoration with high stability, strength and aesthetics (Fig. 12).

Conclusion
Implant treatment proved to be an outstanding treatment modality in a difficult situation. The Hahn Tapered Implant allowed for surgical predictability and reliable osseointegration.

Editorial note: A list of references can be obtained from the publisher.

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