Surgical and Prosthetic Correction of Two Adjacent Anterior Implants A Clinical Case Report

Abstract
Introduction
This clinical case presentation exemplifies the esthetic complications of two adjacent osseointegrated implants placed in the maxillary left central–lateral incisor region of a young female patient with a high smile line and the challenges associated with surgical and prosthetic correction.

Case Presentation
The goal of treatment was to reconstruct the height of the interdental papilla between two adjacent anterior implants to match that of the contralateral teeth and create the proper individual tooth size and proportion of the natural dentition in a stable occlusion. Dermis allograft material was chosen as the graft material because it does not require a donor‐site and it is not dependent on the patient's own tissue volume. Using autogenous tissue could potentially increase the number of surgical procedures and limit the extent of correction. Consecutive surgical procedures using dermis allograft were performed to reconstitute the lost hard and soft tissues. After the height of the interdental tissues was reconstructed to the proper dimensions, then the concept of submerging the implant in a less favorable restorative position and surgically exposing the useful implant was used. A custom implant abutment was fabricated on the exposed left central incisor implant, and two‐unit cement‐retained fixed dental prosthesis (FDP) was fabricated with a cantilevered pontic as the definitive restoration.

Conclusions
Esthetic correction of lost hard and soft interdental tissues was successfully performed through multiple surgical procedures using dermis allograft material. The concept of submerging one implant and engaging the useful one was used to fabricate a two‐unit cantilevered FDP.