Riccardo Kraus 02/11/2016, 10:08 AM

Gingiva discoloration

Dear colleagues, 

I would like to share this case with you: 

A 43-year old female patient was referred to our clinic because of an unpleasant situation in the upper front region.

She wishes an esthetic improvement of the tooth 21, which was root canal treated many years ago.

In the picture you recognise the grayish discoloration of the surrounding gingiva and the opaque, unesthetic PFM crown.

The x-ray shows a massive post and an apical radiolucency.

How would you proceed?

1) Would you perform a revision of the root canal treatment after post removal and restore the tooth with a new crown?

      How would you treat the discoloration of the gingiva?

2) Would you extract the tooth 21 and place an implant?

3) Would you propose an other treatment option?

Thank you  for your comments!

Best regards


Alexis Ioannidis 16/07/2016, 08:46 AM

Complication - Early loss of two implants

What could be the reason for the early loss of these two implants?

After sinus floor elevation 6 months were waited until implant placement. 3 weeks after implant placement, the patient lost a lot of native bone and the implants had to be removed.

Samuel Huber 17/12/2015, 03:08 PM

Labially positioned implant with recession

Dear colleagues

I want to share this complex case with you:

A young 35-year old female patient visited our clinic yesterday for the first time. She is concerned about her implant in position 21 which was placed alio loco, where she remarked a buccal recession.
Clinically the implant is massively bucally angulated and closely placed to the root of the tooth 21.
The patient has very high esthetic expectations and wants to avoid further surgical interventions if possible.
What would you recommend to do?

Thank you for your kind answers and best regards

Anja Zembic 27/04/2015, 08:21 AM

Lack of keratinized mucosa

Dear colleagues,
I would like to share this case with you:

a 59 year old female patient needs a prosthetic rehabilitation of implants 44 and 46.
Medical history: rheumatism, colitis and arthrosis, medication with cortisone.
There is a pronounced lack of keratinized mucosa.

How would you proceed?
1) Would you increase the width of keratinized mucosa?
2) What kind of graft would you use?
(FGG vs. CTS? autologous graft vs. collagen material?)
3) When would you do the treatment, in combination with abutment connection or separate?

Thank you very much for your comments!


Marco Zeltner 16/04/2015, 09:01 AM

Ankylosed tooth: Treatment options/plan

Dear colleagues

I have another case to share with you.

This 19 years old female patient had an accident around 8 years ago with a subluxation of tooth 21 and a subsequent endodontic treatment. Now she feels very uncomfortable with her actual smile. She wants to have a fixed and esthetic solution for her upper front.

Please let me how you would proceed and which treatment options you would propose to the patient considering also her age.

Thank you very very much.


Alain Fontolliet 27/11/2014, 08:28 AM

Soft tissue deficiency prior to implant placement

Hi everybody

A 60-year old woman needs a new reconstruction in the upper right jaw. Tooth 16 is questionnable (PD mesial 6mm, furcation from mesial grade 1). Tooth 14 had to be extracted due to a fracture. After extraction, there is a soft tissue deficiency. The patient is periodontally healthy except tooth 16. How would you proceed now ?

Thanks for your comments...

Husain Harianawala 12/05/2014, 04:53 AM

Patency of the ostium

The patency of the ostium prior to doing a sinus elevation procedure is a must. But what i dont understand is how do we know whether it is patent or not. can it be determined in a cone beam CT scan?
Or should we refer every patient with chronic sinusitis showing a hazy sinus in the radiograph to an ENT surgeon for an endoscopy?

Gary Finelle 21/10/2013, 12:09 AM

Surgical treatment following severe trauma

Dear DC community,
I would like to share with you this interesting case and have your opinion about treatment sequence:
Patient presented in the clinic 3 days after frontal trauma.
No medical condition besides patient is smoker
Clinical Diagnostic: -Expulsion #11 / Intrusion + coronal fracture #21 / 22&12 vital
Radiographic (CBCT) showed double fracture of the alveolar external plate / fracture of internal plate with suspicion of lesion neuromuscular complex (incisal canal)

My treatment plan is the following (please feel free to comment and add your thoughts or concerns):
1. extraction of #21 + CTG to improve soft tissue conditioning
2.Wait 2 to 3 month to aim for Re-consoldation of the fracture alveolar bone (externally & internally)
3. Implant + simultaneous GBR
4.Restorative Phase.

Gary Finelle 07/06/2013, 09:40 PM

Complication following internal sinus elevation

Surgical appointment : Implant placed and simultaneous internal sinus elevation performed (Osteotome technique with DBBM particulate bone).
Post op Xray (attached) was meeting our expectations. surgery was uneventful.
At 2 weeks follow up appointment : Patient reported pain. Slight swelling was visible in the area.
After CBCT acquisition: it seems that membrane got perforated and material released into the sinus cavity.
Infection suspected
Patient was given antibiotic.
Is anybody have any experience with managing these type of complication.
Antibiotic treatment in first intention? Surgical approach (lateral window) to remove material? Implant removal?...

Marco Zeltner 05/06/2013, 12:32 PM

Volume deficiency and coronally displaced mucogingival line after connective tissue graft following implant placement

Situation after implant placement region 11 with simultaneous gbr-procedure followed by connective tissue graft 6 weeks later. Harvesting the graft was extremely difficult due to the lack of palatal volume. Would you suggest any additional grafting procedure for volume gain before performing the abutment connection? How would you transport the mucogingival line more apically? What kind of abutment connection procedure would you prefer?

I'm looking forward to your suggestions.

Marco Zeltner