case_images: PMC11785880_01
case_images: Preoperative and postoperative situation. a Periapical taken when the patient attended the anamnesis. Note the black apical image at the root of tooth #24 and the fractured crown of tooth #25. b Characteristics of the implant used to treat this patient. Note the cylindroconical shape, the 24-degree internal conical connection with its hexagonal index and the in-built 0.25 mm platform-shifting. c Vestibular view of the treated sites upon delivery of the temporary prosthesis. The shape of the crowns is esthetical despite the narrow interimplant distance
case_images: 40729_2025_589_Fig2_HTML.jpg
case_images: PMC11785880_01_40729_2025_589_Fig2_HTML.jpg
case_images: Fig2
case_images: Panoramic and periapical radiologic examination revealed the presence of an endodontic treatment on both teeth, an apical lesion on tooth # 24 and a root fracture of tooth #25 (Fig. 2a). Two cylindroconical implants of O 3.50 x 13 mm (Fig. 2b) were placed in an approximately 1.5 mm infra-osseous position with regard to the vestibular table with an insertion torque superior to 35 Ncm. The placed implants (Top DM, Bioner, San Juan Desvest, SP) are made of titanium grade 23 with an inbuilt 0.25 mm platform-shifting feature and a hexagonally indexed 24  internal conical connection (Fig. 2b). The screw-retained provisional prosthesis was fastened with a 20Ncm torque (Fig. 2c); adjustments were made to bring the crowns out of occlusion.
case_images: Delivery of the final prosthesis after 3 months of provisionalization. a Vestibular view of the prosthesis and the marginal gingiva. The interproximal papilla is closing the embrasure of the ceramo-metallic crowns. b Periapical radiography control after placing the final prosthesis. Note the platform-shifting, the concave prosthetic abutments and the interimplant bone that still lacks maturation
case_images: 40729_2025_589_Fig3_HTML.jpg
case_images: PMC11785880_01_40729_2025_589_Fig3_HTML.jpg
case_images: Fig3
case_images: Figures 3a and b are showing the final implant-supported porcelain fused to metal fixed dental prosthesis that was delivered. Clinical observation showed the presence of the interproximal papilla; the papillae with the adjacent teeth were partially filling the embrasures (Fig. 3a). The periapical radiography revealed the presence of immature bone in a slightly coronal position to the adjacent implant necks (Fig. 3b).
case_images: Periapical examination at the 1-year control. Note the densification of the interimplant bone
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case_images: PMC11785880_01_40729_2025_589_Fig4_HTML.jpg
case_images: Fig4
case_images: At the 1-year radiographic control, the interimplant crestal bone was denser than at 3 months, the coronal limit was well above the implant-abutment connection; it was completely filling the enlarged space between the concave prosthetic abutments (Fig. 4).
case_images: Three-year control. a Vestibular view of the implant-supported rehabilitation. The gingiva looks healthy and the interimplant papilla has grown coronally compared to the previous 3-month control. b Periapical radiography. The interproximal bone is stable
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case_images: PMC11785880_01_40729_2025_589_Fig5_HTML.jpg
case_images: Fig5
case_images: At 3 years, the interproximal papilla was present and completely filling the embrasure of the adjacent implant-supported crowns (Fig. 5a); the interimplant bone crest was stable compared to the 1-year control (Fig. 5b).
case_images: Nine-year control. a Vestibular view of the implant-supported rehabilitation. Note the recession observed at the interimplant papilla and the proximal ones. b Periapical radiography. The interproximal bone is still covering the implant-abutment connection but seems to have lost some coronal height
case_images: 40729_2025_589_Fig6_HTML.jpg
case_images: PMC11785880_01_40729_2025_589_Fig6_HTML.jpg
case_images: Fig6
case_images: By that time, the interproximal papilla suffered a noticeable recession but still the interimplant embrasure remained completely filled; this was not the case for the mesial and distal implant-teeth embrasures (Fig. 6a). The interimplant bone was still present but a slight apical resorption seemed to have happened compared to the 3-year control; nevertheless, bone was still present well above the implant-abutment connection of both implants and covering it (Fig. 6b).
case_images: Ten-year control. a Vestibular view of the prosthesis relying on 2 close implants with an IID of 1 mm. The interimplant papilla and the proximal ones reached a more coronal position compared to the 9-year recall. b Occlusal view of the marginal gingiva after removal of the prosthesis. The soft tissues are looking healthy. c Periapical radiography. The interproximal bone is occupying the entire space between the concave abutments; it is more apical compared to the 9-year control. d Dimensions at the interimplant area. The implant neck served as internal calibration. Note the distance between the collars of the implants, the overall distance between the concave abutments and the height of the interproximal bone. e Measurement of the interimplant distance on the axial axis of the CBCT. The 1.04 mm reading confirms the 1.02 mm IID evaluation on the periapical radiography
case_images: 40729_2025_589_Fig7_HTML.jpg
case_images: PMC11785880_01_40729_2025_589_Fig7_HTML.jpg
case_images: Fig7
case_images: One year later, at the 10-year control, the gingiva appeared healthier; all papillae regained height but only the interproximal embrasure was completely filled (Fig. 7a). The prosthesis was unscrewed to check the peri-implant gingiva; the soft tissues appeared healthy without inflammation (Fig. 7b). On the periapical radiography, the crestal bone levels were well above the implant-abutment connection; the coronal fill of the interimplant space delimited by the concave prosthetic abutments was superior to the previous year (Fig. 7c). Figure 7d shows the various dimensions read on the periapical radiography, the interimplant distance of 1.02 mm, the 2.04 mm room between the concave prosthetic abutments and the 1.40 mm of crestal bone above the implant-abutment connection. At the 10-year control a CBCT examination was also performed before removing the screw-retained prosthesis; the axial section validated the IID measured on the periapical radiography between the collars (Fig. 7e).