implants - international magazine of oral implantology

I user report _ immediate implantation & immediate loading Fig. 5_The implant (Replace Select Tapered, Nobel Biocare) is relatively short owing to the horizontal bone defect (10 mm with diameter 4.3 mm). The planned vertical apical position approximately corresponded to that of the extracted dental root. Fig. 6_ The shoulder of the primarily stable (35 Ncm) inserted implant is located approximately 1 mm apical to the buccal crestal bone edge. The transverse position is approximately 1 mm palatal for optimum distance to the buccal lamella. The buccal orien- tation of one of the three internal channels can be clearly seen. Fig. 7_ The radiograph shows the implant with the temporary abut- ment. The distance from the bone edge to the contact point of the crown is approx. 5 mm owing to marginal bone loss. Fig. 8_The impression coping for open impression taking was screwed on. The implant position was trans- ferred to the laboratory with the help of a plastic key. Fig. 9_In the laboratory, the dental technician prepared a custom-made titanium abutment (Esthetic Abut- ment) and fashioned the temporary composite crown, which was cemented in place just 24 hours after implantation. 38 I implants3_2011 industrialcompanywithattendantsocialobligations, the patient did not want a removable temporary restoration. Because he was also a busy man, it was desirabletoinsertanimmediateimplantwithatem- poraryrestorationwithin24hours,dependingonthe state of the post-extraction alveolus. This procedure involvedaminimumnumberofappointmentsovera clearly defined period. With the help of the clinical findingsandaplanningtemplateusingaradiopaque steelball(panoramicradiograph;Fig.2),itwaspossi- ble to determine the implant length and suitable di- ameterpreoperatively. During extraction with a periotome, great care was taken not to traumatise the hard or soft tissue unnecessarily (Fig. 3). Soft-tissue detachment was thus avoided. The tooth socket was then probed, re- vealing an intact buccal lamella (Fig. 4). The granula- tiontissuepresentwasremoved.Therewasnosignof acuteinflammation.Figure5showsthesizerelation- ship of the extracted root remnants to the implant (Replace Select Tapered, Regular Platform 4.3× 10mm,NobelBiocare).Figure6showstheimplantin- sertedinitsfinalposition.Theimplantshoulderinthe buccaldirectionwasapproximately1mmsub-crestal (seealsoFig.7)withabuccallyorientedchannelofthe internalconnector(Fig.6). Thepalatallydisplacedimplantposition,resulting in a safety distance of up to 2 mm to the buccal wall (bonejumpingdistance),canalsobeseeninFigure6. Followingimplantation,thegapwasaugmentedwith a mixture of Bio-Oss (Geistlich) and endogenous bone. Endogenous bone was removed from the left tuber region with a bone scraper. A covering mem- branewasnotused.Thefollow-upradiograph(Fig.7) shows the correct distances to the neighbouring teeth and the vertical position, corresponding ap- proximatelytothatoftheextractedroot(cf.Fig.2). Theshapeoftheimplantalsocloselymatchesthe conical root shape. In this way, it is possible to avoid perforationofthefacialalveolarwall,especiallyinpa- tientswiththinbuccalbone.Forthisreason,thepilot hole should always be drilled palatally to the natural root tip, and expansion holes should be drilled while exerting pressure in the palatal direction. The area waspreparedinaccordancewiththestandardproto- col. The implant was then inserted with a torque of 35Ncm.Withthisprimarystabilityachieved,themost important requirement for immediate loading was met.Becausethepatientwantedanimmediatehigh- quality aesthetic restoration, fitting a laboratory- fashioned temporary crown of composite material Fig. 5 Fig. 6 Fig. 8 Fig. 9 Fig. 7