Case provided by: PhD, DBA Pantsulaya V. & Dr. Klinkov D. & Dr. Zamanapulov Y.
The management of severe periimplantitis in the aesthetic zone presents a complex clinical challenge, requiring meticulous surgical revision, tissue regeneration, and precise prosthetic rehabilitation. Achieving functional and highly aesthetic outcomes demands a seamless digital workflow. The integration of advanced scanning technologies—such as the Shining 3D Aoralscan Elite—facilitates accurate data acquisition, encompassing both dynamic occlusion and extraoral facial aesthetics, to deliver a truly personalized and predictable restoration.
A 30-year-old female patient presented to the clinic with complications arising from dental implants that had been placed approximately seven years prior. Over the preceding year, the patient had experienced significant gingival bleeding and profuse purulent discharge localized to the implant sites.
Initial radiographic evaluation revealed foci of bone destruction exceeding 5 mm around the existing implants, compounded by a lack of proper crown fit.
· Eradicate Infection and Reconstruct the Defect: Remove the failing prosthesis and implants, utilizing bone substitute materials for immediate ridge preservation.
· Restore Soft Tissue Architecture: Perform targeted soft-tissue augmentation to optimize the emergence profile in the aesthetic zone.
· Functional and Aesthetic Rehabilitation: Deliver a permanent prosthesis guided by individual jaw movements and comprehensive smile design utilizing intraoral and extraoral scanning data.
The initial clinical and radiographic assessment confirmed severe periimplantitis and associated anatomical compromise. Due to the extent of the 5 mm bone destruction and the inadequate fit of the existing prosthesis, the initial treatment phase required the complete removal of both the prosthesis and the failing implants. To mitigate further tissue collapse, the extraction sockets were filled with a bone substitute material for ridge preservation. During the initial healing phase, the adjacent natural teeth were utilized as abutments to support a temporary fixed prosthesis.
Following a three-month healing period, the surgical phase was initiated. Two dental implants were placed in the central incisor region.
To ensure precise spatial positioning, the implant placement was executed using a surgical guide. Concurrently, soft-tissue augmentation was performed in the area of the missing lateral incisors to recreate a natural gingival architecture, which is essential for the final aesthetic outcome.
Three months post-implantation, the restorative phase commenced. A Shining 3D Elite intraoral scanner was utilized in conjunction with scan markers seated at the implant level for data acquisition.
To guarantee the permanent prosthesis was both functional and comfortable, the scanning protocol captured not only the static bite but also recorded the patient's dynamic jaw movements.
Furthermore, an extraoral smile scan was acquired using the Shining Elite to guide the aesthetic design, allowing the clinical team to seamlessly align the facial data with the intraoral scans of the dental arches.
The comprehensive digital dataset, including the dynamic jaw movement trajectories and aligned facial scans, was transmitted to the dental laboratory. Within the exocad design environment, the dental technician utilized the extraoral smile data to determine the optimal proportions. By incorporating specific aesthetic parameters of incisor display in women, the technician meticulously modeled the appropriate height and morphology for the future implant-supported crowns.
The permanent prostheses were successfully delivered and evaluated both clinically and radiographically.
A follow-up CT scan confirmed the precise integration of the permanent prostheses on both the implants and the adjacent natural teeth.
Intraorally, the restoration exhibited ideal white-pink aesthetics, with excellent soft tissue adaptation resulting from the earlier augmentation procedures. The final facial evaluation demonstrated a flawless appearance, with the prostheses harmoniously integrating into the patient's natural smile.
This case demonstrates the efficacy of a comprehensive, digitally driven approach to resolving severe periimplantitis. By leveraging surgical ridge preservation and targeted soft-tissue augmentation, the anatomical foundation was successfully rebuilt. The integration of the Shining 3D Aoralscan Elite proved instrumental in this workflow, accurately capturing critical dynamic occlusal data and extraoral facial parameters to guide the CAD process. The final outcome not only restored function but also achieved a highly aesthetic, predictable result that harmonizes perfectly with the patient's natural facial features.