Correcting loss of a papilla following orthodontic space opening (Atherton´s patch) through implant supported rehabilitation. A case report

The objective of this case report is to describe a surgical and prosthetic technique to create a lost papilla following orthodontic space opening (Atherton´s patch) through implant supported rehabilitation. A switching platform implant was used to replace a left maxillary canine in a unitary interdental edentulous ridge with Atherton´s patch in the distal area of the upper lateral left incisor. The radiographic study revealed correct level of the interproximal bone of the adjacent teeth. A mucoperiosteal flap with crest incision and sulcular extension to the adjacent teeth was made. Special attention was paid to correct position of the implant and the distance (≥ 1.5 mm) between the platform and the roots of the adjacent teeth. A submerged technique was used. Tissue modeling through provisional crown was performed in order to create an ideal emergence profile with total papilla fill recorded at the Atherton´s patch area. Final screw retained CAD-CAM zirconia structure was place. Final follow up was performed 2 years after provisional crown placement, and total fill of both papilla, including at Atherton´s patch area, was recorded. Key words:Atherton´s patch, papilla, switching platform, implant and orthodontics, esthetic score.