the delivery appointment. My experience has been that in time, these lines will disappear completely. In time, I expect the papillae to fill in completely from the mesial of the right cuspid to the mesial of the left cuspid. The points of contact between the crest of bone to the restora-tion contact are all less than 5 mm (Fig. 20). Dr. Tarnow’s studies show that when the measurement from the contact point of the restoration to the crest of the bone is 5 mm or less, the papilla will fill in 100% of the time. 13 Conclusion Pictures of the completed restorations for this patient are shown in Fig. 21. Performing the proce-dures listed below will hopefully ensure restorative success for this patient for many years: ᕡ Guided bone regeneration to establish a liberal bone platform (Fig. 7). ᕢ Secondary bone grafting over each implant at the time of implant placement (Fig. 8). This ensures bone formation at the implant perimeter edges. ᕣ Connective tissue grafting on the inside of the labial flap where the flap overlies each implant helps to increase tissue volume (Fig. 12). ᕤ Conservative management of the tissue at the uncovering of the implant. This also helps to increase the labial tissue volume (Fig. 16). I credit my mentor Dr. Istvan Urban for teaching me these techniques. 7,14 Fig. 20 Fig. 19 References 1. http://www.3m.com/3M/en_US/company-us/all-3m-prod-ucts/~/impregum-penta-soft-Impregum-Soft-Polyether-Impression-(Impregum impression material) 2. http://dentsplymea.com/ceramco-3-application-add-porce-lain (Ceramco 3 porcelain) 3. https://www.geistlich-na.com (Geistlich, Bio-Gide-resorbable barrier, Glycolon suture-resorbable suture) 4. https://www.goremedical.com/suture (GORE-TEX Suture ePTFE Nonabsorbable Monofilament P4K13 CV-4 RT-18 3/8c 18 mm) 5. https://www.henryschein.com/us-en/Search.aspx? searchkeyWord=relyx+unicem+2 (Rely X Unicem) 6. https://www.i-cat.com/ (I-cat scanning) 7. http://www.implant.hu/en/education/courses/3day-advanced-bone-and-soft-tissue-course (Dr. Urban’s Budapest, Hungary Course) 8. http://www.korwhitening.com/ (KoR Bleaching) 9. https://www.nobelbiocare.com/us/en/home.html (Nobel Active implants, healing abutments, impression posts and lab analogs) 10.https://www.osteogenics.com/v/product-family/cytoplast-barrier-membranes/v8/ (Osteogenics, Cytoplast membrane-non-resorbable barrier, Glycolon Absorbable Monofilament DSM 16 Needle ) 11.Newby, Randy K. DDS. An Eight Year Dental Odyssey in the Life of a 22 Year Old Patient Part 3: Guided Bone Regeneration in Deficient Bone Width Sites 7 and 10 in a Post Orthodontic Case. JAOS Winter 2018. Fig. 21 12.Steve’s Precision Dental Lab. 5755 Foxridge Dr. Mission, KS 66202. P: 913.432.6951 http://www.stevespdl.com 13.Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. https://www.ncbi.nlm.nih.gov/pubmed/1474471 14.Urban, Istvan. Vertical and Horizontal Ridge Augmenta-tion: New Perspectives. Quintessence Publishing Co. Ltd, Grafton Road, New Madlen; 2017. www.orthodontics.com Summer 2018 37
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