Immediate Implant Placement and Provisionalization of the central incisors

A 26-year-old female patient is treated following the "MeteenDoor"- protocol. This Dutch protocol includes the placement of a bone substitute simultaneously with Immediate Implant Placement and Provisionalization (IIPP) reducing the horizontal buccal bone changes. It is a predictable treatment procedure where the midfacial recession is avoided when a previous dental element is directly replaced.

The #21 FDI (#9 US) was a Straumann implant, placed in a delayed procedure and temporarily restored when she was referred with a lost #11 FDI (#8 US). The referral asked to replace the #11 FDI (#8 US) immediately. To achieve optimal functional and aesthetic results after implant installation in the anterior maxilla, correct implant positioning and establishment of an optimum volume of hard- and soft- tissues are crucial. Because of the midfacial recession the decision was to replace the implant #21 FDI (#9 US) in the same session following the same "MeteenDoor" procedure. 

In this procedure, midfacial height was gained without opening a flap or performing a Connective Tissue Graft (CTG). The assumption was that this would be the same as replacing an implant instead of a natural tooth. For the provisionalization, "Dutch Design" temporary abutments were used. These are sterilized NobelProcera titanium abutments with resin (BisGMA) temporary restorations. For the final restorations, NobelProcera ZirO2 abutments were used overpressed with E.max press and partial E.max crowns with supragingival outlines.