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A localized and asymmetrical clinical presentation of MIH suggests its concordance with a systemic origin that seems to interfere with amelogenesis, leading to a reduction in hardness and modulus of elasticity of enamel, an increased porosity of 5%–25% compared to normal enamel, an increase in carbon and carbonate concentrations, and an increase in protein content. Clinically, the enamel is soft and porous and undergoes breakdown either soon after the eruption or later under masticatory load termed as posteruptive breakdown. The reported prevalence of this anomaly is 4%–25%. The combination of digital technologies for better data acquisition with updated concepts on soft-tissue management and multilayered zirconia materials facilitates the challenge of restoring a single central incisor in implant dentistry.Molar Incisor Hypomineralization (MIH) which is currently gaining the attention of researchers worldwide is a qualitative developmental defect of the enamel, attributed to a disrupted ameloblastic function and is frequently associated with the incisors and one or more first permanent molars (FPMs). The APC zirconia-bonding concept, aimed at achieving durable, long-term bond strengths to high-strength ceramics, includes three practical steps: (A) air-particle abrasion, (P) zirconia primer, and (C) adhesive composite resin. Important factors for successful, natural-looking restoration of a single maxillary central incisor include soft-tissue architecture, restorative space, restoration contours, texture, color, and translucency. The screw-access hole was covered with gutta-percha and a composite resin. After removal of excess cement and final polishing (Dialite ® ZR Extra-Oral, Brasseler USA, ), the screw-retained crown was delivered and torqued per manufacturer's recommendations. After try-in, the restoration was cemented extraorally to a new ti-base with an adhesive resin cement system (Panavia ™ V5, Kuraray) following the APC concept. A stain and glaze technique was used, as this zirconia material is multi-layered, providing intrinsic color degradation, desirable when restoring single central incisors.

The scan file was sent to the laboratory for elaboration of the final monolithic restoration with a translucent zirconia material (KATANA ™ Zirconia STML, Kuraray, ). After 4 weeks, with the soft-tissue architecture around the implant now corrected, a new scan of the emergence profile was made. The Ti-base (RC Variobase ® C, Straumann) was air-particle abraded with 50-µm aluminum-oxide particles at a pressure of 2.0 bars and fixated to the provisional with a self-curing acrylic resin. After clinical and radiographical evaluation, a digital impression was made (CEREC ® Omnicam, Dentsply Sirona, ), and a PMMA screw-retained provisional was designed and milled to correct the soft-tissue position and create an ideal emergence profile. Meeting the Single Central Incisor Challenge in Implant DentistryĪ 35-year-old woman presented for restoration of a recently placed bone-level implant (BLT 4.1 mm RC, Straumann, ) in site No.

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