24/02/2026
As much as I enjoy managing complex corrective cases, it is always difficult to see the extent of damage that suboptimal prior treatment can cause.
This young patient presented with six splinted zirconia crowns connecting the maxillary anterior teeth. He reported constant discomfort and significant stress. The parafunctional activity that followed was evident in the excessive wear of his lower incisors.
Upon removal of the prosthesis, the underlying situation was far more compromised than anticipated. The maxillary anterior teeth were severely damaged, and ultimately only teeth 22 and 23 could be preserved. I had hoped to maintain 21 to help support the midline papilla; however, only a retained root remained, making preservation impossible.
The treatment plan included multiple extractions followed by extensive GBR. A-PRF with allograft was utilised in the form of sticky bone to enhance buccal alveolar thickness. Three immediate implants were placed in positions 13, 11, and 21.
The implants were immediately loaded with PMMA provisional restorations. After 10 weeks of healing, definitive monolithic zirconia crowns were delivered. Tooth 12 was restored as a pontic supported by 11. All restorations were screw-retained on Ti-bases with angulated screw channels [Dynamic Abutment Solutions]
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