implants - internationalmagazine of oral implantology

I clinical study _ extraction plus technique Tab. 4_Comparison between the result of survey 1 maxilla case B1 and alternatives with the result of survey 2 maxilla case B2 and alternatives. preferred to using it in the maxilla posterior zone. The internal sinus lifting technique was the most prefer- abletechniqueforuseinthemaxillathantheotheral- ternatives. Overall, the clinicians found complicated alternatives, such as the bone distraction and nerve transpositioning techniques, the least preferable. _Clinical case On 24 September 2005, a 49-year-old, healthy, non-smokingmalepresentedwithabilateralfree-end saddle mandible and had worn a removable partial denture for more than 11 years. The patient’s chief complaint was discomfort when eating, which called for the replacement of the posterior missing teeth for functional reasons. The patient’s medical history re- vealednosignificantfindings.Theresultsoftheextra- oral examination showed a normal facial profile and the intra-oral examination revealed missing teeth #35–37 and 45–47 and a removable partial denture (mandible;Figs.1–4).Uponradiographicexamination, an inadequate root canal treatment with peri-apical cystic lesion (tooth #34) and limited alveolar bone height (7–9 mm in length above the inferior alveolar nerve canal) but with an acceptable bone width on both sides of the mandible was confirmed (Fig. 5). During the evaluation of the case, the bone aug- mentationtechnique(GBR)wasintroducedtothepa- tientbutherefusedtoundergothisprocedurebecause itwasdifficultforhimtoaccepttheideaofharvesting bone from other parts of his body for use as the bone graft.Hisotherreasonforrejectingthistreatmentwas hislimitedtimeforvisitsforthelongtreatmentperiod necessary for the procedure suggested. The new ex- traction plus technique was suggested to the patient as an alternative treatment. The treatment would en- tail extracting teeth #34 and 44 and immediately in- sertinglongimplantsinthesitesoftheextractedteeth as support of the short implants to be inserted where thealveolarboneheightislimitedinplaceofthemiss- ing teeth #35–37 and 45–47 (Fig. 6). The patient ac- cepted the treatment. During the surgical procedure, an incision was made from the canine crest of the keratinised gingiva to the distal of the second molar of the left mandible mucosa. After a sulcular incision, the full thickness mucoperiosteal flaps were elevated, exposing the alveolarridge.Usinganon-traumatictoothextraction technique, teeth #34 and 44 were removed with no damage to the surrounding alveolar ridge and the vestibularandlingualboneplatekeptintact.Theperi- apical cystic lesion on the socket was removed by curettage. After preparation of the tooth socket, a 12 mm length implant was placed. Then drilling was doneinregion36toavoidamentalforamen,followed by drilling in regions 37 and 38 at regular 3 to 4 mm distances.Thethreeshortimplantsplacedwere6mm in length and standard ITI Straumann implants, with 4.1diameterand4.8mmplatformdiameter.Thesame procedure was followed on the right mandible, other thanthecurettageofthesocketof44.Primarystabil- ity was achieved in all implants and the submerged surgical approach was followed except for the im- plants placed into the extraction sites. Panoramic ra- diographywasdoneaftersurgery(Figs.6&7).Thepa- tient was prescribed a 625 mg antibiotic and in- structed to rinse with a 0.2% chlorhexidine mouth- wash, use a cold compress and eat a soft diet. Threemonthspost-treatmentthepatientreturned forafollow-uptreatmentanditwasfoundthatallim- plants had gained osseointegration successfully and healing caps were provided. The prosthetic phase was begunon1April2006,whichwaslaterthantheusual timeowingtothepatient’stravellingtimetable.Prob- ing of the peri-implant soft tissue found that it was healthyandtherewasnobleedingaroundthemucosa oftheimplant.Itwasdecidedtotakethefinalimpres- sionforprosthodonticsusingtheimpressioncapsand synOcta positioning cylinder (Straumann) to obtain the master cast (Figs. 8 & 9). After selection of the ap- propriate abutments, a metal framework was con- structed and the prosthetic procedures followed the protocoluntilthecorrectseatingoftheprosthesiswas achieved and cemented in the patient’s mouth (Figs. 10–16)._ 24 I implants4_2011 Maen Aburas,DDS,MSc Omaya Medical Center P.O.Box 21494 Dubai,UAE Ralf Gutwald,MD,DDS,PhD Hugstetter Str.55 79106 Freiburg/Breisgau,Germany ralf.gutwald@uniklinik-freiburg.de _contact implants Table IV