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15 CASE STUDY ISY – THE INNOVATIVE IMPLANT SYSTEM IS BECOMING EVEN MORE FIRMLY ESTABLISHED IN DENTAL PRACTICES Dr. Maximilian Blume, Frankfurt am Main The past few years have seen a myriad of new ideas develop in our eld of work with many established systems being put under close scrutiny based on a changing awareness of economics, science, and innovation. Innova- tions should primarily aim to make improvements, with the tried and true revealing itself in the process and the super uous pruned away. In the eyes of Bob Dylan, “a man is a success if he gets up in the morning and gets to bed at night, and in between he does what he wants to do.” Innovation and limitation contradict one another – even when working, a tool should enable its user to work creatively and freely and to implement the best ideas. Since the introduction of the iSy Implant System, it has become more and more rmly established in our depart- ment, particularly in situations where it becomes apparent that it creates freedom for both the clinician and the patient. It would be short sighted to label the iSy system as a cost-effective alternative for limited indications because it opens up enormous opportunities, mostly in the details, that only become apparent at second glance. Details that sometimes make the critical difference and in many aspects are even unique. Initial ndings The 22-year-old patient presented for ad- vice to the implant outpatient clinic of the Clinic for Oral and Maxillofacial Plastic Sur- gery at the Frankfurt University Hospital for the rst time in 2014. Her primary con- cerns at the time were agenesis of tooth 12, in place of which tooth 13 was moved using orthodontics, and a missing tooth 26 that had been extracted four months prior. Both gaps had not been provisionally restored at the time of the initial presen- tation. The initial exploratory ndings in- dicated a preserved, well cared for and periodontally normal, youthful dentition. Along with the agenesis of tooth 12, mi- crodontia of tooth 22 was also observed (Fig. 1 and 2) . The patient met all the prerequisites for a safe, planned implantation with transgingi- val healing [1, 2]. The clinical and radiolog- ical examinations classi ed the bone bed horizontally and vertically as suf cient with a broad band of attached gingiva covering the bone bed. Augmentation measures around the hard and soft tissue were thus not indicated. The patient wanted to eliminate both gaps; a bridge restoration was discussed as an option, but after explaining the bene ts and drawbacks, a restoration of this type was ruled out. Along with the insertion of two implants, the restoration of an har- monious and symmetrical anterior upper jaw using the adhesive technique was also planned together with the patient. The pa- tient declined surgical crown lengthening of tooth 22. The preservation of hard and soft tissue throughout the entire treatment and ele- vation procedure was prioritized, and in the anterior area in particular the chal- lenge was to achieve a balanced and natu- ral red/white esthetics [3, 4]. Implantation treatment sequence The procedure proceeded without any problems under local anesthesia and was carried out in accordance with the standard iSy protocol. The implant bed was revealed using a minimally invasive crestal incision with the basal part of the attached gingiva of the vestibular and Fig. 1: The initial exploratory ndings for the patient revealed periodontally normal dentition with agenesis of tooth 12 and microdontia of tooth 22. Fig. 2: Instead of absent tooth 12, the incisor was moved using orthodontics.