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A chairside immediate provisional crown for single dental implantation in aesthetic area: A case report
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(a, b) Clinical and radiograph of the patient's first visit; (c, d) disinfect and anesthesia of working area; (e, f) incision using blade no. 15 and full-thickness flap elevation; (g) mechanical debridement using curette Gracey; (h) bone graft and bio-adsorbable membrane were applied to the surgery area; (i) suturing was done; (j) composite wire splinting was applied after suturing; (k) clinical finding 1 week post-surgery; (l–m) Clinical and radiograph finding three months post-surgery).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sri Oktawati, Trisantoso Rezdy Asalui, Adam Mardiana, Sri Pamungkas Sigit Nardiatmo, Hardianti Maulidita Haryo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Sri" "apellidos" => "Oktawati" ] 1 => array:2 [ "nombre" => "Trisantoso Rezdy" "apellidos" => "Asalui" ] 2 => array:2 [ "nombre" => "Adam" "apellidos" => "Mardiana" ] 3 => array:2 [ "nombre" => "Sri Pamungkas Sigit" "apellidos" => "Nardiatmo" ] 4 => array:2 [ "nombre" => "Hardianti Maulidita" "apellidos" => "Haryo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2603924920300264?idApp=UINPBA00004N" "url" => "/26039249/00000003000000S1/v1_202006110931/S2603924920300264/v1_202006110931/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "A chairside immediate provisional crown for single dental implantation in aesthetic area: A case report" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adam Mardiana, Sri Pamungkas Sigit Nardiatmo, Hardianti Maulidita Haryo, Wahyuni Wahab, Muhammad Harun Ahmad" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Adam" "apellidos" => "Mardiana" "email" => array:2 [ 0 => "mardianaadam@gmail.com" 1 => "pmc@agri.unhas.ac.id" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sri Pamungkas Sigit" "apellidos" => "Nardiatmo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Hardianti Maulidita" "apellidos" => "Haryo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Wahyuni" "apellidos" => "Wahab" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Muhammad Harun" "apellidos" => "Ahmad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Periodontology Department, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pedodontic Department, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 467 "Ancho" => 1500 "Tamanyo" => 75542 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) The clinical picture of #22, inadequate filling and 1.5<span class="elsevierStyleHsp" style=""></span>mm recession, 1<span class="elsevierStyleHsp" style=""></span>mm recession on #24. (B) Occlusal view, show mesial-distal available space #23 region. (C) Periapical radiography, show available vertical space, bone crest resorption.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A dental implant has been used in dental practice for more than three decades and well accepted as a therapy for edentulous patients.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> This high acceptance of dental implants has made greater expectations from both patients and clinicians in the success of this therapy. In many years, osseointegration of the fixture has been used as the main focus in many studies and research to raise the implant survival rate. Nowadays, with the development of implant surface treatment, osseointegration can be considered as a predictable biologic phenomenon. However, osseointegration of the implant does not ensure patient satisfaction, especially on the aesthetic area.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> so that why the functional and aesthetic outcome becomes an indication of successful dental implant treatment. Smith and Zarb extended these criteria by indicating a successful implant must have an adequate aesthetic appearance. The aesthetic outcome is determined by healthy and stable peri-implant tissue.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">According to many previous studies, many researchers believed that after implantation in the jaw for a future prosthesis, titanium implants should be left submerged to undergo a healing process before they are capable of functional loading. This healing process, which is called osseointegration, could be achieved entirely in a period from 3 to 6 months. The reason for the delayed loading was to avoid micro-movement on the implant, which could interfere with the healing process. If this situation occurs, connective tissue can grow at the interface between the implant surface and the bone.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> The result would be the failure of the implant due to not being able to resist the masticatory forces. The original two-stage procedure with delayed implant loading has been modified over the years with the introduction of early and immediate loading protocols, in the attempt to reduce treatment time and patient discomfort. With the increasing demand for a quicker and shorter treatment time, the concept of implant placement protocol in conjunction with immediate provisional has received great attention.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This case report aimed to provide an alternative of immediate temporary crown that can be done in the chairside immediately after implant surgery.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case presentation</span><p id="par0020" class="elsevierStylePara elsevierViewall">A fifty-four-year old-women came to Hasanuddin University Dental Hospital wanted to replace her missing upper left canine. She has been used a removable denture for over than five years and felt comfortable with it, but a year ago, she heard about dental implant treatment that has a better comfort than her denture. She comes to the hospital with high expectation to get a better outcome for her missing upper left canine replacement and wanted the treatment procedures did not affect her appearance.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There were no systemic disease and allergic history. A dental examination showed edentulous ridge was found on #23 with 1<span class="elsevierStyleHsp" style=""></span>m m gingival recession on #22 and #24. The inadequate and overhanging filling was on #22 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Periapical radiography examination showed a reduction of alveolar bone around 3<span class="elsevierStyleHsp" style=""></span>mm on adjacent teeth (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). 11<span class="elsevierStyleHsp" style=""></span>mm mesial-distally available space was measured from the study model and 13<span class="elsevierStyleHsp" style=""></span>mm vertical available space from the alveolar crest to the sinus base. On the labial-palatal aspect, 7.5<span class="elsevierStyleHsp" style=""></span>mm bone thickness was measured with a bone mapping technique. Base on the patient condition, a proper discussion was done, and we decided to put a 4<span class="elsevierStyleHsp" style=""></span>mm diameter with 10<span class="elsevierStyleHsp" style=""></span>mm height single implant with immediate provisional crown procedures for her treatment with screw-retained type prosthetic.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The surgery was done on the first visit. Middle crestal incision was made and full-thickness flap elevation was done to get access to the bone. Initial bur was drilled in the bone crest and the parallel pin was inserted to check the angulation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The normal bone type was detected and the drilling stops at 4<span class="elsevierStyleHsp" style=""></span>mm diameter drill with 10<span class="elsevierStyleHsp" style=""></span>mm height (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). A Tapered Implant with 4<span class="elsevierStyleHsp" style=""></span>mm diameter and 10<span class="elsevierStyleHsp" style=""></span>mm height was inserted in the drilling site with 1<span class="elsevierStyleHsp" style=""></span>mm below the crestal bone. Primary stability was measured with a manual torque wrench and showed 45<span class="elsevierStyleHsp" style=""></span>Ncm in the last torque. 1.5<span class="elsevierStyleHsp" style=""></span>mm residual bone thickness has remained on the implant palatal aspect and 2<span class="elsevierStyleHsp" style=""></span>mm thickness on the labial. A rigid abutment with 4<span class="elsevierStyleHsp" style=""></span>mm diameter and 4<span class="elsevierStyleHsp" style=""></span>mm height was placed and a provisional crown was built on the rigid cap. Composite resin was manually put on the rigid cap and formed to be left upper canine directly at the chairside. After gaining an ideal shape and polished well, the provisional crown was put on the rigid abutment and sutured were performed to close the flap. We used 5–0 blue nylon suture with 18<span class="elsevierStyleHsp" style=""></span>mm reverse cutting needle to minimize the trauma. Free occlusal loading was ensured by eliminating the occlusal contact. Clindamycin 300<span class="elsevierStyleHsp" style=""></span>mg, mefenamic acid 500<span class="elsevierStyleHsp" style=""></span>mg, and chlorhexidine oral gargle were given after surgery.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The suture was removed ten days after surgery and very good healing showed on the wound area. Fixture level impression was done after 9.5 weeks and the gingiva emergence profile was very good with a small black triangle on the mesial and distal of the crown (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Two weeks later the screw-retained final restoration was placed. The patient was very satisfied with the treatment outcome, especially because she did not experience the edentulous period after the surgery.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Restoration a single tooth loss with an implant-supported crown has become a preferred rehabilitation treatment option.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In the anterior maxilla, osseointegration alone is not sufficient; patient satisfaction is a key factor in the success of implant therapy. Provisional implant restorations are essential tools used by restorative dentists to optimize aesthetic outcomes for single-tooth implant restorations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> It is become a choice because of the reduction of the treatment period, patient discomfort, and the patient get the aesthetic immediately after the implantation procedure. Time reduction was gain bay the single-step operation procedure by using immediate provisional crown without waiting for the healing process or osseointegration achievement. This healing process, which is called osseointegration, could be completely achieved in a period from 3 to 6 months.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">This one-stage surgery with provisionalization become a challenge for healing process, because of micromovement that can be happened during this period that can lead into osseointegration failure.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Block et al., in a review of the literature, found reported implant success rates ranging from 91% to 97.8% when implants were loaded with a provisional restoration.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> A study showed an implant survival rate of 91.7% for immediately loaded implants at the two years of follow-up. Over the past 20 years, some studies and trials have reported similar results with trans-mucosal implants compared with submerged implants. As a result, it is not necessary to submerge the implants under the mucosa during the healing period, which eventually introduced the immediate loading protocol.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Adequate primary stability is the main prerequisite to apply an immediate provisional protocol. Secure mechanical retention of the implant into the host bone is necessary to prevent implant-bone micromovements, which could lead to a failure of the osseointegration process.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Trisi et al., explained that between the implant and peri-implant bone, there should be a minimum gap, although without there being micromotions over the threshold, that could cause a deformation of the newly formed tissue able to destroy the new cells and vessels that have formed in the gap, determining the penetration of the osteoclasts that induce the bone resorption.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">There is no universal consensus about the minimum primary stability threshold to reach for a safe application of immediate provisional protocols; however, implant stability quotients (ISQ) >60–65 or peak insertion torques >35<span class="elsevierStyleHsp" style=""></span>N<span class="elsevierStyleHsp" style=""></span>cm are mostly accepted as minimum values.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Riskalah et al., insertion torque undoubtedly play an important role in the primary stability and successful osseointegration of implants, there seems to be no correlation between insertion torque and implant failure above 35<span class="elsevierStyleHsp" style=""></span>Ncm threshold of insertion torque.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The measurement of the moment of force (torque) necessary to insert an implant in its lodging place in the bone is a parameter for studying initial stability. The higher the implant insertion torque, the higher will be the initial stability reached.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The bone density also become a consideration in immediate loading provisional restoration. Immediate provisional or fully loading restoration may be considered a valid therapeutic choice, even in low-density bone, as long as at least 45<span class="elsevierStyleHsp" style=""></span>N/cm of insertion torque is reached.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Implant design parameters such as implant surface, thread configuration, and body shape have a correlation relationship, that will define the initial stability of the implant. It is believed implant sites using a tapered design, and surface modification can increase the primary stability in the low-density bone. Furthermore, recent experimental preclinical work has shown the possibility of attaining primary stability of immediately loaded, tapered dental implants without compromising healing and rapid bone formation while minimizing the implant stability loss at compression sites. A tapered-screw implant design will provide adequate stability because it creates pressure on cortical bone in areas of reduced bone quality. Building on the success of traditional tapered implant therapy, newer tapered implant designs should aim to maximize the clinical outcome.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The patient need of aesthetic, in this case, can be provided by the used of immediate provisional that build in the chairside. Functionally as aesthetic, this procedure also reduced the number of surgical visits, advantages of a bimodal approach involve less patient morbidity and enhanced maintenance of peri-implant soft tissue margin, and aesthetics. Due to the high aesthetic demands in the anterior maxilla as well as the patient's disaffection towards removable provisionals, immediate provisional restoration of single-tooth implants has gained popularity provided that satisfactory primary implant stability is reached.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The immediate provisional restoration carried soft tissue support and subsequent optimization of peri-implant soft tissue aesthetics with regards to papilla preservation and stability of the gingival margin.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The raised of the black triangle on the distal and mesial of the crown is because of the bone resorption that has been happening during 5 years post-extraction and the used of removable prosthesis. The 3<span class="elsevierStyleHsp" style=""></span>mm resorption of the bone from the normal height position made the distance between bone crest with the proximal contact of the crown become 6<span class="elsevierStyleHsp" style=""></span>mm long. Tarnow et al. (1992) investigated the effect of the distance from the contact point to the crest of bone on the presence of the interproximal dental papilla and found out that when the measurement from the contact point to the crest of bone was 5<span class="elsevierStyleHsp" style=""></span>mm or less, the papilla was present almost 100% of the time.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Long term aesthetic outcome was primary patient demand on single dental implantation in aesthetic area. With the precise treatment consideration, immediate provisional loading on single implantation can get high survival rate. A chairside immediate provisional crown after a single implantation procedure is a very good alternative to get an aesthetic, functional, morbidity, and shorter treatment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1346923" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Case" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1239506" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Case presentation" ] ] ] 3 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussions" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-29" "fechaAceptado" => "2019-07-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1239506" "palabras" => array:4 [ 0 => "Aesthetic area" 1 => "Dental implantation" 2 => "Immediate loading" 3 => "Provisional crown" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Functional and aesthetic outcome is an indication of successfully dental implant treatment. Single implant with chairside immediate provisional crown loading is preferred treatment for patient aesthetic demand and implant survival success.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This case report is to show an alternative procedure to get good functional, aesthetic, less morbidity, and reducing treatment period with a chairside immediate provisional crown.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 54 years old women wanted to replace her missing upper left canine with a dental implant. She hoped that this procedure would not affect her appearance. A single implant with 4<span class="elsevierStyleHsp" style=""></span>mm diameter and 10<span class="elsevierStyleHsp" style=""></span>mm height was placed in the upper left canine area. A rigid abutment was installed, and a chairside provisional crown was built at a rigid cap immediately after surgery.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A chairside immediate provisional crown after a single implantation procedure is a very good alternative to get an aesthetic, functional, morbidity, and shorter treatment.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Case" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life (WOSQUAL-2019). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 467 "Ancho" => 1500 "Tamanyo" => 75542 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) The clinical picture of #22, inadequate filling and 1.5<span class="elsevierStyleHsp" style=""></span>mm recession, 1<span class="elsevierStyleHsp" style=""></span>mm recession on #24. (B) Occlusal view, show mesial-distal available space #23 region. (C) Periapical radiography, show available vertical space, bone crest resorption.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 455 "Ancho" => 1250 "Tamanyo" => 64977 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A) Local infiltration technique. (B) Palatal local aesthetic.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 633 "Ancho" => 1250 "Tamanyo" => 93294 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(A) Parallel pin to check the ideal drilling position. (B) Periapical radiography, show the location and angulation among the parallel pin with the adjacent teeth.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1187 "Ancho" => 1750 "Tamanyo" => 162672 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">(A) A chairside provisional crown on #23 with composite resin material. (B) Shaping and polishing #23 temporary crown. (C) Labial aspect the provisional crown after suturing procedures. (D) Periapical radiography, show the position of the implant and rigid abutment after provisional crown loading and suturing procedures (E).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1034 "Ancho" => 1500 "Tamanyo" => 163061 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Gingival margin profile from labial view after 9.5 weeks. (B) Occlusal view of gingival emergence profile. (C) Screw retained final prosthetic. (D) Labial view of Screw retained final prosthetic insertion, show a good gingival margin and a little black triangle.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A detailed decision tree to create, preserve, transfer, and support the emergence profile in anterior maxillary implants using custom abutments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Grizas" 1 => "S. Kourtis" 2 => "E. Andrikopoulou" 3 => "G.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 91 | 17 | 108 |
| 2024 September | 81 | 22 | 103 |
| 2024 August | 64 | 24 | 88 |
| 2024 July | 75 | 14 | 89 |
| 2024 June | 63 | 8 | 71 |
| 2024 May | 78 | 12 | 90 |
| 2024 April | 91 | 19 | 110 |
| 2024 March | 102 | 12 | 114 |
| 2024 February | 78 | 13 | 91 |
| 2024 January | 123 | 6 | 129 |
| 2023 December | 91 | 7 | 98 |
| 2023 November | 136 | 16 | 152 |
| 2023 October | 134 | 31 | 165 |
| 2023 September | 77 | 3 | 80 |
| 2023 August | 53 | 7 | 60 |
| 2023 July | 57 | 10 | 67 |
| 2023 June | 74 | 8 | 82 |
| 2023 May | 110 | 8 | 118 |
| 2023 April | 91 | 5 | 96 |
| 2023 March | 73 | 7 | 80 |
| 2023 February | 51 | 5 | 56 |
| 2023 January | 41 | 12 | 53 |
| 2022 December | 61 | 6 | 67 |
| 2022 November | 51 | 15 | 66 |
| 2022 October | 37 | 13 | 50 |
| 2022 September | 46 | 16 | 62 |
| 2022 August | 34 | 10 | 44 |
| 2022 July | 33 | 12 | 45 |
| 2022 June | 23 | 7 | 30 |
| 2022 May | 27 | 11 | 38 |
| 2022 April | 24 | 20 | 44 |
| 2022 March | 34 | 11 | 45 |
| 2022 February | 37 | 10 | 47 |
| 2022 January | 30 | 12 | 42 |
| 2021 December | 36 | 19 | 55 |
| 2021 November | 56 | 20 | 76 |
| 2021 October | 45 | 13 | 58 |
| 2021 September | 25 | 15 | 40 |
| 2021 August | 23 | 4 | 27 |
| 2021 July | 15 | 6 | 21 |
| 2021 June | 11 | 9 | 20 |
| 2021 May | 18 | 11 | 29 |
| 2021 April | 39 | 6 | 45 |
| 2021 March | 22 | 8 | 30 |
| 2021 February | 10 | 7 | 17 |
| 2021 January | 7 | 2 | 9 |
| 2020 December | 4 | 9 | 13 |
| 2020 November | 3 | 8 | 11 |
| 2020 October | 1 | 3 | 4 |
| 2020 September | 9 | 9 | 18 |
| 2020 August | 5 | 11 | 16 |
| 2020 July | 15 | 11 | 26 |
| 2020 June | 1 | 1 | 2 |
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