Fig. 1: Agenesis of 22, opening of orthodontic space.
Fig. 2: Line of intermediate smile. The smile uncovers the papillae and reaches the collar of the incisors (12 and 22 are supported by implants).
Fig. 3a: Average forms, types and dimensions of the lateral incisor according to Papathanassiou.
Fig. 3b: Proximal view photographs showing 10 anatomical variants of lateral maxillary incisors described by the author.
Fig. 4: According to Levin, following the golden ratio, the width of the lateral incisor y = 0.62 x and, for Preston, it is 0.66 x (images from Papathanassiou).
Fig. 5: Evidence of bone deficit at 22 (case shown in Fig.1).
Fig. 6: Simulation of location of 3mm implant in cross section (case shown in Fig.1).
Fig. 7: Evidence of radicular convergence.
Fig. 8: Orthodontic layout of implant corridor.
Fig. 9: Diastemas created around a riziform tooth to obtain a space of 6mm.
Fig. 10a: Centered location of zenith of 22 (a) (arrow) to be taken into account when making the crown 12 (b).
Fig. 10b: Centered location of zenith of 22 (a) (arrow) to be taken into account when making the crown 12 (b).
Fig. 11: Cortical graft in place, shaped to support future papillae (case as shown in Fig. 1).
Fig. 12: X-ray result, compare with Fig. 6.
Fig. 13: Clinical outcome 5 months after the graft. Compare with Fig. 11.
Fig. 14: 3 mm diameter Nobel Active implant.
Fig. 15a: Papillary view (b) X-ray view (a), 2 years after the insertion of the implant.
Fig. 15b: Papillary view (b) X-ray view (a), 2 years after the insertion of the implant.
Fig. 16: Mobile Anyray 2 (Vatech) X-ray generator.
Fig. 17: Intraoperative X-ray, Precision Drill inlay (left on picture) and in situ (right on picture).
Fig. 18: Clinical outcome 5 months after the graft. Postoperative X-ray Nobel Active 3/0 implant and 15° abutment in place.
Fig. 19: Initial situation.
Fig. 20: De-epithelialisation of a palatal flap into a diamond shape.
Fig. 21: Unfoldment of palatal flap, vestibular edge.
Fig. 22: Creation of flap envelope, Swann-Morton blade through the envelope. SM 63, inlaid with transparency.
Fig. 23: Passage of suture through the envelope.
Fig. 24: The palatal flap is folded into the vestibular envelope using a suture thread.
Fig. 25: Tissue integration with ceramic crown.
Fig. 26: Vestibular bulge obtained with modified flap.
Fig. 27a: Clinical and X-ray views, vitroceramic in place.
Fig. 27b: Clinical and X-ray views, vitroceramic in place.
Fig. 27c: Clinical and X-ray views, vitroceramic in place.
Fig. 28: Initial incision creating two vestibular half papillae.
Fig. 29: Suture of half papillae (situation in Fig. 1).
Fig. 30: De-epithelialisation tuberosity graft.
Fig. 31: Insertion of connective graft buried under the papillae.
Fig. 32: Clinical outcome in a case of gummy smile.
Fig. 33: Insufficient soft tissue thickness alters the chromatic outcome.