Home / Planned, printed, placed.

Two implants in the aesthetic zone, provisionals the same day.

Central and lateral incisor replaced through a tooth-supported template — with screw-retained provisionals whose subgingival profile was shaped in the laboratory before the surgery, not negotiated with the tissue afterwards.

Sites

21 · 22

Guide

Tooth-supported

Approach

Flapless

System

MegaGen Blue Diamond

Planning

R2GATE

Immediate provisionals

The case

An upper left central and lateral incisor — FDI 21 and 22 — missing,
restored with two implants placed through a guide and provisionalised on the day of
surgery.

A healed anterior ridge is, on paper, the easy version of this problem: no socket to
take stability from, no extraction on the day, no fresh bone to protect. What it does not
remove is the part that actually decides whether the case succeeds.

Intraoral view of the anterior maxilla before surgery, showing the edentulous span at 21 and 22 — The situation before surgery: the edentulous span at 21 and 22, and the standing anterior teeth either side of it that the template will seat on.

Why the aesthetic zone changes the problem

Everywhere else on this site, the argument for planning is depth, angle and available
bone. Here it is different. The bone decides whether the implant survives; the emergence
profile decides whether anyone believes it.

Which is why the most interesting object in this case is not the guide. It is the pair
of screw-retained provisional crowns on titanium bases, photographed off the mouth, with
the subgingival profile already shaped in the laboratory. They were made before the
surgery, from the same plan the template came from. So the tissue was never allowed to heal
into a shape that would later have to be corrected; it healed to the profile the definitive
restoration was going to want.

That is the same principle as the patient-specific healing abutment on
case 01, taken one step further — here the shaping
component is the provisional tooth itself.

The evidence supports this narrowly and honestly: trials of patient-specific versus
stock components at implant placement report better preservation of soft tissue volume and
papilla height and higher pink esthetic scores, with no difference in marginal bone level.
It is a soft-tissue argument, and in the aesthetic zone the soft tissue is the result.

Two screw-retained provisional crowns on titanium bases, photographed off the mouth — The two provisionals on titanium bases, before surgery. The subgingival contour is laboratory work done in advance — not a shape argued with the tissue after healing has already started.

Why this guide

A tooth-supported template. In the anterior maxilla the adjacent teeth are rigid, they
cannot compress, and they sit immediately either side of the two sites — which makes
them close to an ideal reference. The template carries both sleeves and open inspection
windows, so seating is confirmed visually rather than assumed.

The surgery was flapless: the osteotomies were prepared and the implants placed through
the template without raising or reflecting tissue in the aesthetic zone, where the papillae
are the part of the result nobody can rebuild afterwards.

The printed tooth-supported template with two guide sleeves and inspection windows — The template as printed: two sleeves, occlusal rests, and open windows over the supporting teeth.

The template seated in the mouth, occlusal view, both sleeves over the ridge — Seated in the mouth. Seating is checked through the windows before the first drill enters a sleeve.

System and software

Site	Tooth	Fixture ref	Diameter	Length
21	Central incisor	ARO3711	Ø 3.7 mm	11 mm
22	Lateral incisor	ARO3310	Ø 3.3 mm	10 mm

Planning screen for site 21 showing the implant position against the CBCT sections and the surface scan — Site 21, checked against the volume and the surface scan in the same view.

Planning screen for site 22 showing the implant position against the CBCT sections and the surface scan — Site 22. Both positions were reviewed and approved before manufacture.

Outcome

Site	Insertion torque	ISQ
21	71 Ncm	91
22	65 Ncm	85

Occlusal view of the two screw-retained provisionals seated at 21 and 22 with the screw access channels visible — The provisionals seated on the day of surgery, screw access visible. From here the tissue heals against the shape the definitive restoration will want.

Frontal intraoral view of the restored anterior segment at 21 and 22 — The restored anterior segment. Even gingival architecture across the two implant sites and the natural teeth beside them.

In one line

Two anterior implants placed flapless through a tooth-supported template and loaded the
same day — with the emergence profile decided in the laboratory beforehand, because in
the aesthetic zone the soft tissue is the result.