Atypical implant situations 659

the arch (Fig. 15-96) . After cleansing with peroxide, the hollowed-out interior was packed with a filling material that takes on the same shade as the tooth.* The crown was replaced, positioned properly, and re-moved before the material hardened. After hardening in hot water for 5 minutes, the tooth was refitted and readjusted. A twin arch band with a rigid wire extending lingually to the center of each neighboring tooth was provided by the orthodontist (Fig. 15-97) .

*Adaptic, made by Johnson & Johnson, New Brunswick, N. J.

Fig. 15-99. A maxillary arch with six loose teeth and a large anterior diastema.

The band was cemented over the original tooth crown with hard cement, and the crown was cemented over the implant post. After removing the hardened excess cement, the natural tooth crown was ligated with .010 stainless steel to the labial arch wire for support during bone regeneration (Fig. 15-98).

Case 10

Restoring a maxillary arch with a large anterior diastema

Dealing with a large space between two maxillary incisors is particularly difficult when the few remaining anterior teeth are periodontally involved. A cumbersome removable appliance would seriously threaten such teeth. As for the diastema, the patient may be used to it and also fear that obliterating the gap will make the central incisors undesirably large and bulky. In such a situation, Linkow uses posterior blade type implants to permit full arch splinting and yet still maintain the anterior diastema.

      In this case there are six anterior periodontally involved teeth, including only a root of the right
cuspid, and a large diastema between both central incisors (Fig. 15-99) . The teeth were prepared, and
castings made with palatal extensions emanating from the lingual shoulders of the central incisor copings.
The copings were not over-built to close the diastema.
      The castings were fitted in the mouth and a wax

Fig. 15-100. The anterior restoration—both quadrants joined by a palatal plate—was fitted in the mouth. The diastema was still present.

Fig. 15-101. Blade implants were set into the two posterior edentulous areas.