implants - international magazine of oral implantology

I user report _ immediate implantation & immediate loading 40 I implants3_2011 was planned. An open impression was taken with a custom tray (Fig. 8). In order to minimise the labora- tory time required, the implant position was trans- ferredtotheoriginalmodelbymeansofaplastickey (Pattern Resin, GC Europe). The titanium abutment usedforthetemporarycrown(EstheticAbutment)is characterisedbyscallopededgesthatfollowthesoft- tissue contours and provide support (Fig. 9). In order to achieve further optimisation, the abutment was custom-made by the dental technician. However, it wasstillpossibletomakefineadjustmentsinsituwith thehelpofrotatingcarbide-tippedinstruments. Just 24 hours after implantation, the custom abutmentandthetemporarycompositecrownwere fitted (Figs. 9 & 10). Correct seating of the abutment ontheimplantwascheckedwiththehelpofadental radiograph (cf. Fig. 7). Care was taken when fashion- ing the crown to avoid static or dynamic contact points.Thiswasrecheckedinsitu.Thecrownwasthen fixed in place with temporary cement (TempBond, Kerr Dental). The patient was also instructed to exert as little pressure as possible on the crown when eat- ing. Three months later, after a new impression had beentaken,acustomProceraEstheticAbutment(No- belBiocare)wasscrewedintoplace,andthefinalfull ceramic CAD/CAM crown was fixed using glass- ionomer cement (Fig. 10). The Periotest score for the implantwasverygoodatthisstage(-7). _Result and prognosis Despite the recession and less than optimum fit of the restorations of the neighbouring teeth, the crown blended in harmoniously with the surround- ing teeth. Soft-tissue integration was also convinc- ing. The immediate implantation with immediate temporary restoration yielded a quick, straightfor- ward and aesthetically attractive result in just a few sessions and without a removable temporary restoration.Thismetthepatient’swishes,andhewas accordingly delighted with the result. Distress causedbythesinglesurgicalinterventionwasmini- mal.Theprognosisoftherestorationisalsogood.The literature shows that the procedure leads to stable long-term results in both the crestal bone and soft tissue.13 The same applies to the Replace Select Ta- pered implant system used. In a case study with 66 implantsin48patients,noneoftheimplantswaslost over a period of five years, and the hard and soft tis- sues remained healthy.9 The biologically optimised TiUnite surface, which promotes fast and reliable deposition of bone cells, also contributed to this favourable outcome.13, 14 However, the procedure described here also car- riesrisks.Theoutcomecanbeaffectedbyerrorsindi- agnosis,indicationandexecution.Inthepresentcase, only a panoramic radiograph with a reference stan- dard was prepared in advance for diagnostic pur- poses. Because the circumstances of the case were ideal,moreelaborateprocedureswerenotrequired.If additional information and safety margins are de- sired, working with 3-D diagnostic techniques and possibly computer-aided implantation is recom- mended.Inmanycases,itisnotnecessarytoprepare a flap. This spares the patient, as in the present case, and helps the peri-implantation tissue heal without complication. TheReplaceSelectTaperedimplantsystemusedis distinguished by a high degree of user friendliness. Thewellthought-outandstraightforwardprocedure makesitparticularlysuitableforintegrationinmod- ern implantological/surgical referral practices that aim to involve the prosthetist and dental technician activelyinthetreatmentprocess._ Editorial note: A list of references is available from the publisher. Fig. 10_Two months later the soft tissue was stable and free of inflam- mation. The temporary crown was designed in such a way that there were no static or functional contact points. Fig. 11_A new impression was taken another four weeks later. A zirconium dioxide abutment was screwed in, and the final full ceramic CAD/CAM crown was put in place. The patient was delighted with the result. Dr Rouven Bönsel Center of Oral Surgery Freienhof 4 34393 Grebenstein bei Kassel,Germany praxis@drboensel.de _contact implants Fig. 10 Fig. 11