Background: Especially in the anterior region, late implantation can lead to unsatisfactory aesthetic soft tissue results. This case report is intended to demonstrate a possibility to achieve aesthetic soft tissue contours and emergence profiles even in late implantations.
Case report: In February 2022, a then 27-year-old courier cyclist presented to the Interdisciplinary Ambulance Centre of the Department of Oral and Maxillofacial Surgery Münster after a fall. Teeth 11 and 21 were avulsed (non-recoverable); tooth 22 had a complicated crown-root fracture and was also not worth preserving. For insurance reasons, the implantation could not take place until 5 months after the accident. In the meantime, the patient was treated with a deep-drawn splint designed for maximum papilla preservation. Three Straumann implants BL 3.3 mm (10/12/12 mm) were placed in region 11, 21, and 22. After another three months, the implants were uncovered and the emergence profiles were designed with PMMA crowns. Over a period of three months, the PMMA crowns were successively adjusted in the subgingival area to ensure the most aesthetic soft tissue contouring possible. For the definitive restoration, individualised zirconium abutments on a titanium adhesive base were fabricated and restored with fully veneered zirconium crowns. Due to the long shaping phase with PMMA crowns, highly aesthetic results could be achieved even though implant placement took place only 5 months after the accident.
Discussion: Several studies have already addressed the shaping of implant crowns (including temporaries) and the transfer of the emergence profile to the definitive model in order to achieve aesthetic results. The case presented takes up several of these approaches to achieve aesthetic results here with delayed implant placement and restoration.