Attached File 1- (MiNi Clinical Case Report Dr. Achraf Souayah - MINEC)2

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  ! # %&'()*  +,%- .-/0.1 #2*)3 456 ,78529 %:;2&28#2<:=3 1;=>'>2   Before Surgery Clinical Case CASE REPORT A 19-year-old female patient visited with a chief complaint of remplacing her missing maxillary lateral incisors. It was acknowledged that agenesis of the maxillary lateral incisors is the cause of her teeth absence.The challenge for practitioners treating lateral incisor agenesis involves space opening or closure, with the advantages and drawback related to this alternative. In collaboration with the orthodontist, the treatment plan was to manage a correct space to use implant-retained prostheses. In particular, in cases of adjacent teeth devoid of any fillings or color or size issues, placing a single tooth implant may be regarded as the most conservative approach. At the first radiograph and clinical examin ation (Fig. 1,2,3), the patient has a high lip line, and she manifested high esthetic expectations. Special attention should be paid to the interpretation of X-ray documents, notably the panorexes. A Cone Beam CT is systematically required before implant placement in such situation to assess the boundaries of the implantable bone (Fig.4). =()5=2<:=2? /5:'@)7<A) !;?<B+)=()5 '(;C& 9:5 !>=> >*@?2=( '&'()* Fig.1.  Lip line evaluation evaluation, A:  lateral view, B:  front view Fig.2.  Intra-oral initial situation, front view Fig.3.  Panoramic radiograph, A:  Implant site 12, B: Implant site 22 Fig.4.  Preoperative cone beam CT A:  Implant site 12, B: Implant site 22Note the the ridge and alveolar bone atrophy due to long-term absence of teeth A BA BA B  Space analysis / Digital smile design To replace a maxillary lateral incisor, the orthodontist needs to create at least a 6mm space at neck level between the central incisor and the canine. To the diameter of the narrowest 3mm implant must be added a 1.5mm space on each side of the implant. Mini™ implant system with internal connection (MegaGen Implant Co. Lld. Gyeongbuk, South Korea) seems to be a good option to be used in maxillary lateral sites and lower incisors. The small implant diameter perfectly fit the mesio-distal diameter of these teeth, and allow to create an ideal emergence profile.The DSD tool (digital smile design) was used to analyse the space distribution. It’s based on a specific photo protocol and drawing some lines and forms over them. The DSD protocol is characterized by effective communication between the interdisciplinary dental team, including the dental technician. Team members can identify and highlight discrepancies in soft or hard tissue morphology and discuss the best available solutions using the amplified images. The space analysis of this case shows a bigger MODspace kept to the tooth #12 compared of the MOD space of the tooth #22. A special attention will be given to this discrepancy during the implant surgery and temporization phase. Clinical Case CASE REPORT =()5=2<:=2? /5:'@)7<A) !;?<B+)=()5 '(;C& 9:5 !>=> >*@?2=( '&'()* The assessment of the space available mesiodistally is crucial to evaluate the diameter of the implant. In unilateral congenitally missing lateral incisor cases, the contralateral lateral incisor may be used for assessing the proper mesiodistal space needed. In cases of peg-shaped contralateral lateral incisors or when both lateral incisors are congenitally missing, other tools have to be used. One of these tools may be a formula initiated by Chu:Central incisor= width in mm= XLateral incisor=X-2 mm Canine=X- 1 mmAttention has to be given to the minimal mesiodistal width that is needed for the implant placement. A minimum of 5.5 mm is required. There should be at least 1 mm distance between the implant and the adjacent teeth; otherwise, the interproximal bone could be  jeopardized, and the space for the papilla between the implant crown and adjacent teeth is constricted and appears much shorter than the papillae on the contralateral side. 39 A disagreeable esthetic outcome would be the result. A B CFig.5.  Intra-oral close-up images A:  Right lateral view, B:  front view, C:  Left lateral view Fig.6.  Intra-oral close-up images, occlusal views. Notice the concave buccal contour of the ridge. Fig.7.  DSD analysis. The yellow dotes shows where the right canine should be moved for better smile outcome  Digital Smile Design of the case
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