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 561

The ABC Protocol in the Esthetic Zone:

A Comprehensive Surgical and
Prosthetic Approach

Athanasios Ntounis, DDS, MS1/Lillie M. Pitman, DMD1 Dental agenesis of permanent teeth
Adrien Pollini, DDS2/Ricardo Vidal, DDS, MS2 is a common condition with an inci-
Wei-Shao Lin, DDS, MS2/Michael P. Madigan, DMD3 dence that ranges from 2% to 10%.1
Henry Greenwell, DMD,MSD2 Excluding third molars, the teeth
most commonly affected are lateral
incisors, premolars, and canines.2
The purpose of this article is to present a surgical and restorative protocol The lack of permanent tooth dental
for the replacement of missing teeth in the esthetic zone. The ABC protocol follicle formation and absence of the
consists of digitally guided implantation, autogenous bone graft (A), eruption process is often associated
followed by bovine bone xenograft (B) and connective tissue graft (C).
with hard and soft tissue deficiencies
Autogenous bone is placed in contact with the implant surface to induce
osseointegration; bovine bone xenograft is then applied to augment the and orthodontic space problems.
ridge dimension and provide long-term stability. Connective tissue is used to The use of implants for restoration
provide additional volume. The ABC biomaterial sequence offers favorable of congenitally missing teeth is as-
hard and soft tissue dimensions and immediate provisional restoration sociated with patients who have
predictably leads to an esthetically pleasing definitive prosthesis. (Int J undergone orthodontic space open-
Periodontics Restorative Dent 2015;35:561–569. doi: 10.11607/prd.2170)
ing and maintenance until growth
is complete. Completion of growth
is determined by a series of cepha-
lometric radiographs taken at least
6 months apart. Patients are usually
referred for delayed implant place-
ment in early adulthood. Early or
delayed implantation scenarios in
the esthetic zone also present with
similar challenges. Usually, resorption
has occurred after extraction loss of
anterior teeth.3 The patients’ esthetic
expectations are commonly high,
and an individualized risk assess-
ment is required before undertaking
Private Practice limited to Periodontics and Implants, Fredericksburg, Virginia, USA.
1
implant therapy. This article presents
2Department of Oral Health & Rehabilitation, School of Dentistry, University of Louisville, a comprehensive periodontal and
Louisville, Kentucky, USA.
3Private Practice limited to Periodontics and Implants, Knoxville, Tennessee, USA. prosthetic protocol for replacing
congenitally missing teeth with im-
Correspondence to: Dr Athanasios Ntounis, Department of Oral Health & Rehabilitation, plant restorations. The key elements
School of Dentistry, University of Louisville, 501 South Preston, Room 312, Louisville, KY
of this protocol are image-guided
40202-1701, USA; fax: (502) 852-1317; email: perio.ntounis@louisville.edu.
implantation surgery and the use of
©2015 by Quintessence Publishing Co Inc. an onlay composite graft consisting

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562

Fig 1a Facial aspect of edentulous space. Fig 1b Occlusal aspect of edentulous

Notice the facial concavity as well space. Siebert Class I defect is evident.
as the abundance of keratinized tissue.

of autogenous bone graft (A), bovine canine guidance. No interferences Digital Imaging and Communica-
bone xenograft (B), and a subepi- were noted during excursive move- tions in Medicine (DICOM) file was
thelial connective tissue graft (C). In ments. The temporomandibular joint imported into Virtual Implant Place-
addition, immediate provisional res- examination did not reveal signs and ment software (VIP 3; Biohorizons).
torations are used to create optimal symptoms of pathology. Adequate Radiographic analysis revealed
peri-implant tissue architecture dur- prosthetic space was confirmed after 5.5 mm of space to accommodate a
ing the healing process. impressions, records, and mounting 3.0-mm implant with approximately
on a semiadjustable articulator. 1 mm safety distance from the roots.
In the coronoapical dimension, the
Case 1 platform was planned 3 mm from
Case management the facial free gingival margin of
Clinical presentation the central incisor.5 In an orofacial
dimension, placement ensured that
A 27-year-old man with a noncontrib- Presurgical evaluation the implant body is in native bone,
utory medical history presented with A wax-up was performed and a du- though sagittal plane analysis re-
a chief complaint of a missing right plicate cast was fabricated with type vealed a narrow two-wall defect on
lateral incisor. The patient reported a 3 dental stone (Microstone, Whip the facial aspect, resulting in a facial
history of orthodontic treatment and Mix). An impression of the opposing dehiscence. At completion of vir-
space maintenance with a remov- arch was made and a cast was fabri- tual planning, the data were sent to
able retainer. Clinical examination cated. Maximum intercuspation was Biohorizons for fabrication of a Pilot
revealed absence of periodontal dis- chosen as the maxillomandibular Compu-Guide surgical template.
ease or other pathology. A Siebert relationship of treatment. A cement- The template dictated the angula-
Class I defect4 was present at the retained single implant prosthesis tion, depth, and location of the initial
site of the congenitally missing right was planned. A computed tomogra- 2-mm osteotomy.
lateral incisor, combined with a nar- phy (CT) scan appliance prescription
row soft and hard tissue concavity was made and the casts were sent to
extending to the mucogingival junc- Biohorizons for fabrication of the CT Surgical and restorative
tion (Figs 1a and 1b). The occlusal scan appliance. The appliance con- procedure
examination revealed a stable maxi- tained three fiduciary markers. A CT
mum intercuspation with anterior scan was taken of the patient with One hour before the procedure, a
disclusion at protrusion and bilateral the appliance seated intraorally. The loading dose of 2 g of amoxicillin

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 563

Fig 2a Occlusal aspect of the ridge archi- Fig 2b A 3.0-mm implant during Fig 2c Implant platform po-
tecture. Notice two-wall facial defect of the placement. A 1.5-mm clearance sitioned 3 to 4 mm apical to
initial 2.0-mm drill. from adjacent teeth was ensured. the facial free gingival margin
of adjacent teeth.

and 600 mg of ibuprofen was ad- was noted on the facial aspect of stabilize the CT graft just below
ministered. A 60-second, preproce- the implant, confirming the radio- the crown margin, using polyglac-
dural rinse with chlorhexidine 0.12% graphic findings. The harvested au- tin 910 sutures (Vicryl, Ethicon). The
was performed, and the lower face togenous bone chips were placed flap was approximated with single
was scrubbed with a chlorhexidine as the first layer, followed by small vertical mattress sutures on the pa-
2% antibacterial soap for 60 sec- granules (0.25–1 mm) of deprotein- pillae, and the vertical incision was
onds. A crestal incision was made, ized bovine bone mineral (DBBM) sutured with C3 5.0 chromic gut su-
extending intrasulcularly on the fa- (Bio-Oss, Geistlich Pharma) to re- tures (Perma Sharp, Hu-Friedy). An
cial aspect of the central incisor and store the normal contour of the additional sling suture was placed
canine teeth. The papilla between ridge. A radiograph was taken to through the facial flap and connec-
the canine and first premolar was evaluate final implant position. A tive tissue graft to increase stability
preserved and a vertical beveled polyetheretherketone temporary around the provisional crown. Oc-
incision was made on the distal line abutment was customized and clusion was evaluated to ensure no
angle of the canine. A full-thickness connected to the implant and a contact on the temporary crown in
flap was elevated for visualization provisional crown was fabricated maximum intercuspations or excur-
of the crest to the most apical ex- using acrylic resin. During abut- sions. Postoperative instructions
tent of the defect. The Compu- ment preparation, care was taken to included soft diet, avoidance of an-
Guide surgical template was seated place the restorative margin 0.5 to terior teeth use, as well as antibiot-
and initial preparation was done 1 mm below the future free gingi- ics (amoxicillin 500 mg three times
using a 2.0-mm pilot drill to final val margin. After crown fabrication, a day for 7 days) and ibuprofen
depth of 12 mm (Fig 2a). During a free connective tissue graft was 600 mg every 6 hours as needed.
osteotomy, autogenous bone chips harvested from the palate, using a In addition, chlorhexidine 0.12%
were collected and preserved in single-incision technique (Fig 3a). wt/vol rinse was prescribed. The
sterile saline. Without additional The connective tissue graft was patient was evaluated at 1 week
preparation of the implant bed, a positioned on the xenograft to pro- and then every month (Fig 4). At 4
3.0 × 12-mm two-piece implant tect the graft and to enhance soft months after surgery, the provision-
was placed (Laser-Lok, Biohorizons) tissue volume (Fig 3b). The provi- al crown was removed and an im-
(Figs 2b and 2c). Underprepar- sional crown was cemented (Temp- plant impression was made using a
ing the osteotomy allowed for fi- Bond Clear, Kerr) before suturing, modified impression coping, which
nal insertion torque of 35 Ncm. A to enable removal of all excess ce- reproduced the provisional restora-
narrow, vertical, deep concavity ment. A sling suture was used to tion emergence profile.6

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564

Fig 3a (left) Autogenous bone chips placed facial to

implant, followed by an onlay of xenograft, and finally a
subepithelial connective tissue graft, satisfying the ABC
protocol. Note the temporary abutment used.

Fig 3b (right) Note soft tissue thickness.

a b
Fig 4 Facial view showing 2-week healing. Fig 5a Initial clinical presentation. Note discrepancy of the gingival margins between
lateral incisors and canines.

Fig 5b Panoramic radiograph demonstrating advanced root resorption of maxillary anterior

lateral incisors. Note adequate space between roots of adjacent teeth in areas of both teeth.

Case 2 significant root resorption of both and connected to a templiX plate

maxillary lateral incisors and lack of (Straumann). The templiX plate con-
Clinical presentation lamina dura (Fig 5b). The occlusal tained three reference pins that al-
examination revealed stable max- lowed for consistent orientation
A 24-year-old woman presented imum intercuspation with anterior during digital surgical planning
with the following chief complaint: disclusion at protrusion as well as bi- and surgical template fabrication.
“Two of my front teeth are loose lateral canine guidance. No interfer- A cone beam tomography scan
and my orthodontist referred me ences were noted during excursive of the patient was taken with the
for implants.” The medical history movements. radiographic template in place.
was noncontributory. The patient The DICOM file was imported in
reported a history of orthodontic CoDiacnostiX implant planning
treatment at age 11 years, which Case management software (Straumann). Radiographic
included extraction of upper and analysis revealed 7.5 mm between
lower first premolars. Clinical exam- adjacent teeth to accommodate a
ination revealed degree 1 mobility Presurgical evaluation 3.3-mm implant with approximate-
of the maxillary lateral incisors and Impressions were made and di- ly 2 mm safety distance from each
absence of periodontal disease or agnostic casts were fabricated. A root. Despite the noted concavity
other oral pathology (Fig 5a). The radiographic template was fab- of the premaxilla, surgical planning
radiographic examination revealed ricated from clear acrylic resin indicated that implants would be

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 565

Fig 6a Surgical planning and virtual implant positions took place

in the Co-DiacnostiX Software (Straumann).

Fig 6b Surgical guide in place after extraction of teeth.

a b

entirely surrounded by native bone. anesthesia was administered. The 35 Ncm was achieved. The harvest-
Two cement-retained crowns were same incision designs were used ed autogenous bone was placed
planned as the final prostheses as described previously, beginning first, followed by a layer of DBBM to
(Fig 6a). Implant planning took place with the right and then the left lat- restore the natural ridge contours
following the same principles as de- eral incisor. The deciduous lateral (Fig 7a).
scribed for case 1. At completion of incisors were removed with forceps. Two prefabricated abutments
virtual planning, the data were used The right deciduous lateral incisor were connected to the implants.
to fabricate a surgical template with was ankylosed and bone forma- The abutments were selected after
the Straumann gonyX. tion was noted in the pulp cham- evaluating the dimensions of soft
ber. Excess bone was removed and tissue in relation to the position of
preserved in sterile saline. A round the prosthetic margin. Because ce-
Surgical and restorative diamond bur was used on the crest ment-retained provisional restora-
procedure of the ridge to accommodate a nor- tions were used, care was taken to
mal emergence profile. The surgical ensure that prosthetic margins were
The patient was premedicated template was positioned and two not positioned more than 0.5 to
and prepared for surgery in the 3.3 × 12-mm bone level implants 1 mm apical to the gingival margin.5
same fashion as case 1. The surgi- (Straumann) were placed according According to the ABC protocol, a
cal template was tried, and after to the aforementioned principles 20 × 15 × 2-mm free connective
an accurate fit was ensured, local (Fig 6b). A final insertion torque of tissue graft was harvested (Fig 7b)

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566

Fig 7a (left) A prefabricated definitive

abutment was used for provisionalization.
Note the layer of xenograft placed as onlay.

Fig 7b (right) Single incision to harvest

subepithelial connective tissue graft.

Fig 7c Placement of subepithelial connec- Fig 7d Facial view after suturing. Note Fig 7e Facial view after provisional crown
tive tissue graft over xenograft. peri-implant mucosa thickness and orienta- fabrication.
tion of abutments.

Fig 8a Facial view of provisional crowns Fig 8b Presentation at 1 week after crown Fig 8c Occlusal view at 1 week after crown
and mucogingival architecture, 1 month delivery. delivery.
postoperatively.

and sectioned in two halves. The The use of prefabricated abut-

two pieces were positioned bilater- ments allowed for fabrication of
ally to cover the augmented areas. cement-retained provisional resto-
Each CT graft was stabilized with rations with a definitive margin that
a modified vertical mattress sling was easy to capture. A vacuform ma-
around the abutment, using poly- trix was used to fabricate provisional
glactin 910 sutures (Fig 7c). The flaps crowns with acrylic resin. Temporary
were repositioned and held with cement (TempBond Clear) was used
slight coronal tug to stretch elastic (Fig 7e). Occlusion was verified us-
fibers back to their position before ing 0.8-mm shim stock to avoid any
Fig 8d Final periapical radiographs.
flap elevation. The vertical incision contacts in static and dynamic oc-
was closed first using interrupted clusion. Postoperative instructions
chromic gut C3 5.0 sutures and pa- and prescriptions were the same as
pillae were approximated with inter- described in case 1. The patient was
nal vertical mattress polyglactin 910 evaluated at 1 and 2 weeks and then
sutures (Fig 7d). every month (Fig 8).

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 567

Outcomes

Both cases received 4 months of

postsurgical follow-up before de-
finitive restoration. The provisional
restorations were used to register
the emergence profile and maintain
Fig 9a Facial view of provisional resto- Fig 9b Occlusal view of provisional res-
soft tissue architecture. In the first ration and mucogingival complex at 4 toration and mucogingival complex at 4
case, a UCLA abutment was used, months. months.
while in the second case two zirconi-
um dioxide abutments (Straumann)
were selected and lithium disilicate
crowns were fabricated. The crowns
were delivered using resin-based ra-
diopaque cement (Multilink, Ivoclar-
Vivadent) (Figs 8 and 9).

Fig 9c Gold alloy UCLA abutment at Fig 9d Final restoration the day of cemen-
delivery. tation.
Discussion

The technique presented here is

used for replacement of congeni-
tally missing teeth in the esthetic
zone. It is a combination of well-
established treatment modalities,
namely, guided surgery planning
and placement; use of the ABC sur-
gical protocol, consisting of autog-
enous bone particles, bovine bone
particulate graft, and connective
tissue as onlay grafts; and finally
immediate provisional restoration. Fig 9e Periapical Fig 9f Final restoration 2 weeks after
radiograph on the cementation.
Guided implant surgery allows day of delivery.
for predictable accurate position-
ing of the implant in challenging
cases like those presented herein.
The absence of a permanent tooth of placement challenges such as ad- bility and minimum peri-implant tis-
follicle leads to alveolar atrophy, jacent root proximity, which require sue remodeling over time. With the
causing deficient implantation sites. maximum accuracy. present technique, a layer of bovine
Although the use of computer-guid- In cases with dehiscence noted bone xenograft is applied to aug-
ed implant placement has the same on the facial aspect, the autogenous ment the ridge dimension and pro-
demands and challenges,7 it offers bone layer is in proximity with the vide long-term stability. DBBM has
great accuracy during implantation implant surface to induce osseoin- low substitution rate and provides
surgery. In the cases presented, tegration. Optimum esthetic results long-term dimensional stability in
guided surgery was used because require long-term dimensional sta- augmented sites.8 Anorganic bovine

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568

bone mineral has high calcium con- of healing, especially if grafting has shown to provide stable long-term
tent and has been shown to remain occurred.16 A properly contoured results. The present technique
in augmented sites after a period of provisional restoration allows for shares similar concepts with con-
10 years.9 development of interdental papil- tour augmentation, such as use of
This technique also offers ex- lae as well as facial tissue volume at locally harvested autogenous bone
cellent osteoconductivity and bio- their maximum capacity for an op- chips and DBBM as onlay grafting
compatibility. Histologic studies timal esthetic result.17 In a cohort of materials. Despite the similarities,
have shown direct apposition of 55 patients, Jemt18 showed that us- significant differences should be
newly formed bone around bovine ing provisional crowns may restore noted. Unlike contour augmenta-
bone residual particles.9,10 Bovine soft tissue contour faster than heal- tion, this technique allows for trans-
bone mineral has been successfully ing abutments alone, and Su et al17 mucosal healing with the use of an
used as onlay graft in esthetic zone introduced the concept of gradual immediate provisional restoration,
reconstruction.11–13 Another prop- modification of the critical and sub- instead of submerged healing. The
erty of bovine bone mineral is the critical contour to achieve optimal ABC protocol uses connective tis-
high crystallinity and natural white soft tissue architecture with pro- sue grafts to enhance soft tissue
color. These characteristics offer visional restorations. The present volume and complement immedi-
high opacity that can mask visible technique maximizes this ability by ate provisional restorations. At the
changes from restorative materials.14 increasing soft tissue volume with 12-month follow-up, the two cases
Connective tissue is used to connective tissue graft. Attention presented herein showed dimen-
provide additional tissue volume. needs to be paid in the provision- sional stability of the peri-implant
Grunder8 showed reduced vol- alization stage to avoid any occlusal tissues.
ume loss in a cohort of patients contacts as well as any loosening The proposed protocol is indi-
who received immediate implants of the retention screw or failure of cated for cases in which the osseous
when connective tissue grafts were the temporary cement. Such com- architecture allows for prosthetically
placed on the facial aspect. In ad- plications may lead to unfavorable driven implant placement within
dition, Linkevicius et al15 showed loading and compromise osseoin- the contour of the alveolus but with
that initial soft tissue thickness is an tegration. In addition, care needs resulting dehiscences on the facial
important factor to prevent crestal to be taken to avoid overcontour- aspect. Prospective clinical trials
bone remodeling around implants ing of the provisional crown and are required to evaluate the effec-
in a 1-year period. Less than 2 mm violate soft tissue space.17 tiveness of the ABC protocol for re-
of soft tissue thickness may lead to Similar grafting layering tech- placement of congenitally missing
up to 1.45 mm of crestal bone loss.15 niques have been used for guid- teeth. Such studies should focus on
Immediate provisionalization ed bone regeneration around evaluating long-term dimensional
offers great potential in influenc- implants and have shown encour- stability as well as histologic results
ing peri-implant tissue architecture, aging results. The sandwich bone of the proposed biomaterial combi-
because immediate connection augmentation technique uses nation.
takes advantage of the ongoing layers of cancellous and cortical
peri-implant tissue establishment.6 bone allograft in combination with
In addition, it enhances the wound bovine pericardium membrane. Conclusions
healing dynamic, providing stabil- Results demonstrated significant
ity at the interface between the hard tissue thickness gain as well The ABC protocol for replacement
soft tissue flap and the restorative as peri-implant tissue stability for of missing teeth in the esthetic
materials. Significant hard and soft the duration of the study.19 Con- zone uses computer guided im-
tissue changes take place at the in- tour augmentation presented by plantation surgery, two bone fill-
terface during the first few months Buser and coworkers13 has been ers, as well as a connective tissue

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 569

graft to enhance tissue volume and 6. Ntounis A, Nguyen M, Pelekanos S, 13. Buser D, Wittneben J, Bornstein MM,
achieve optimal esthetics. Connec- O’Neal SJ, Liu P. Screw- versus cement- et al. Stability of contour augmenta-
retained restorations for provisionaliza- tion and esthetic outcomes of implant-
tion of an immediate provisional tion of implants. Clinical Advances in supported single crowns in the esthetic
crown achieves esthetic rehabilita- Periodontics 2012;2:200–216. zone: 3-year results of a prospective study
7. Hultin M, Svensson KG, Trulsson M. with early implant placement postextrac-
tion and influences formation of the Clinical advantages of computer-guided tion. J Periodontol 2011;82:342–349.
peri-implant mucosa, taking advan- implant placement: A systematic review. 14. Jung RE, Sailer I, Hammerle CH, Attin
tage of the ongoing wound healing Clin Oral Implants Res 2012;23(suppl 6): T, Schmidlin P. In vitro color changes of
124–135. soft tissues caused by restorative mate-
dynamic. 8. Grunder U. Crestal ridge width changes rials. Int J Periodontics Restorative Dent
when placing implants at the time of 2007;27:251–257.
tooth extraction with and without soft 15. Linkevicius T, Puisys A, Linkeviciene L,
tissue augmentation after a healing pe- Peciuliene V, Schlee M. Crestal bone
Acknowledgments riod of 6 months: Report of 24 consecu- stability around implants with horizon-
tive cases. Int J Periodontics Restorative tally matching connection after soft tis-
Dent 2011;31:9–17. sue thickening: A prospective clinical
The authors would like to thank Dr Celin Arce 9. Sartori S, Silvestri M, Forni F, et al. trial. Clin Implant Dent Relat Res 2013
for the prosthetic restoration of the first case Ten-year follow-up in a maxillary sinus (Epub ahead of print).
presented. The authors report no conflicts of augmentation using anorganic bovine 16. Degidi M, Daprile G, Nardi D, Piattelli
interest related to this study. bone (Bio-Oss). A case report with his- A. Immediate provisionalization of im-
tomorphometric evaluation. Clin Oral plants placed in fresh extraction sockets
Implants Res 2003;14:369–372. using a definitive abutment: The cham-
10. Schlegel KA, Fichtner G, Schultze- ber concept. Int J Periodontics Restor-
References Mosgau S, Wiltfang J. Histologic find- ative Dent 2013;33:559–565.
ings in sinus augmentation with au- 17. Su H, Gonzalez-Martin O, Weisgold A,
togenous bone chips versus a bovine Lee E. Considerations of implant abut-
1. Vastardis H. The genetics of human tooth
bone substitute. Int J Oral Maxillofac ment and crown contour: Critical contour
agenesis: New discoveries for under-
Implants 2003;18:53–58. and subcritical contour. Int J Periodon-
standing dental anomalies. Am J Orthod
11. Schneider D, Grunder U, Ender A, tics Restorative Dent 2010;30:335–343.
Dentofacial Orthop 2000;117:650–1176.
Hammerle CH, Jung RE. Volume gain 18. Jemt T. Restoring the gingival contour
2. Arte S, Nieminen P, Apajalahti S, et al.
and stability of peri-implant tissue fol- by means of provisional resin crowns
Characteristics of incisor-premolar hy-
lowing bone and soft tissue augmenta- after single-implant treatment. Int J
podontia in families. J Dent Res 2001;
tion: 1-year results from a prospective Periodontics Restorative Dent 1999;
80:1445–1450.
cohort study. Clin Oral Implants Res 19:20–29.
3. Covani U, Ricci M, Bozzolo G, et al.
2011;22:28–37. 19. Fu JH, Oh TJ, Benavides E, Rudek I,
Analysis of the pattern of the alveo-
12. Buser D, Chappuis V, Bornstein MM, et Wang HL. A randomized clinical trial
lar ridge remodelling following single
al. Long-term stability of contour aug- evaluating the efficacy of the sandwich
tooth extraction. Clin Oral Implants Res
mentation with early implant placement bone augmentation technique in in-
2011;22:820–825.
following single tooth extraction in the creasing buccal bone thickness during
4. Seibert JS, Cohen DW. Periodontal con-
esthetic zone: A prospective, cross- implant placement surgery: I. Clinical
siderations in preparation for fixed and
sectional study in 41 patients with a 5- and radiographic parameters. Clin Oral
removable prosthodontics. Dent Clin
to 9-year follow-up. J Periodontol 2013; Implants Res 2014;25:458–467.
North Am 1987;31:529–555.
84:1517–1527.
5. Buser D, Martin W, Belser UC. Optimiz-
ing esthetics for implant restorations in
the anterior maxilla: Anatomic and sur-
gical considerations. Int J Oral Maxillo-
fac Implants 2004;19 Suppl:43–61.

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