Initial situation with 45 fractured just before its extraction Insertion of the 3.5 mm diameter Neobiotech IS-II implant by means of guided surgery to be sure to insert the implant in correct 3D position, and to avoid any injury to the adjacent roots As soon as the implant is inserted, the thickness and height of the soft tissues are checked. If the vertical dimension is at least 3mm, then no soft tissue graft is required. It can be seen that during the extraction maneuvers of the tooth, the fracture of the ceramic crown was caused on 46. A temporary abutment of the thinnest possible size is screwed in, notches are created in it to increase the retentive effect and some Teflon is packed inside to prevent resin from entering during the relining of the provisional crown Immediately prior to relining, the provisional with positioning tabs is tested to ensure that it fits correctly Once the provisional relining is complete, a healing screw is screwed in and the primary stability of the implant is measured with AnyCheck. The IST value was 68 with a 6mm high healing screw, and then the stability of the implant was ideal to procede with an immediate provisionalization. The gap between the implant and the buccal bone plate was filled with heterologous biomaterial to better maintain the buccal bone. The biomaterial is inserted up to the gingival margin to give support also to the soft tissues. The provisional crown at the end of its finishing and polishing At the end of the surgery the provisional crown was screwed and its height was reduced to remove it from both static and dynamic occlusal contacts. A collagen sponge was inserted between the crown and the gingival margin to protect the biomaterial. 10 days after surgery, the soft tissues already show ideal healing Initial radiograph showing the curvature of the root which would have made freehand implant insertion difficult. Final X-ray testifying the correct implant insertion in the3D positions of the space and the correct screwing of the temporary abutment.

Initial situation with an old prostheses rehabilitation that need to be replaced the canine needs to be extracted for the presence of a fracture and a destroying decay to get an ideal provisional prostheses management was decided to postpone the implant insertion, and to procede with a socket preservation in order to preserve the alveolar bone and the soft tissue contouring as best as it was possible 4 months after the surgery, the implant was inserted with the help of an instrument that give us the ideal distance between the first drill and the adjacent roots (Implant Misura MR - LM Dental) without arise any flap. after 6 months with the provisional screw-retained crown on the canine, the case was finalised with a screw-retained Zirconia-ceramic crown on the canine and Zirconia-ceramic layered crowns and porcelain veneer on the other teeth at a close up it is evident how the canine restoration is well integrated with the other restorations, and the soft tissue are healthy and with an absolutely natural appearance. The parabola is perfect and also the papillae are competent X-ray at 3 years from the implant insertion. The bone levels are stable and the implant is very well integrated

The patient presented a temporary Maryland Bridge to hide a left upper canine in evident palatine position. After repeated attempts to get an orthodontic therapy accepted to bring the malpositioned canine back into the arch, she decided to extract it and proceed with the implant-regenerative therapy. Maryland Bridge in position 2.3 The canine in palatine position 3 months after the canine extraction and the delivery of a new provisional Maryland bridge It is evident a bone dehiscence buccally to the implant Some bone chips harvested with ACM Drill from the mandibular angle have been positioned over the implant surface then some bone substitute (Calcitos, Biotech, ITA) has been placed over the autologous bone to increase the volume, to reduce the harvest reabsorption and to create a root bone prominence with a natural shape The Cytoplast non reabsorbable membrane fixed with the cover screw and two pins in apical position at 6 months later as just having removed the membrane it is evident the amount of the regenerated bone a connective tissue graft is positioned to increase the volume and the soft tissue quality after 6 months of tissue maturation with the provisional screw-retained crown, the tissues are ready for the definitive restoration Final definitive Zirconia-ceramic screw-retained crown at two years from the surgery in a frontal view the definitive crown in a lateral view. It is evident the quality of both the ceramic crown and of the shape, volume, and texture of the surrounding soft tissue the smile now is pleasant the final X-ray