implants - internationalmagazine of oral implantology

I user report _ revision 36 I implants4_2011 gionoftheneck,losingtheprostheticcrown(Fig.1). Figure 2 shows the situation on an X-ray image. The patient was treated with antibiotics (Clindamycin 900 mg/d), the planned intervention was explained to the patient and the removal of the implant and newimplantplannedfortwodayslater.Afterprepa- ration of a trapezial flap with a crestal incision and removal of the ceramic implant (Fig. 3), the deep- seated epithelium and connective tissue was re- moved and the remaining bony cavity prepared for theplacementofanewimplantwithagreaterdiam- eter(Fig.4).Theremainingimplantbedwasrevealed tobeaverysolidcorticalstructure,suchthatathread had to be pre-cut for the new implant (Fig. 5). The IMPLAimplant(SchützDentalGroup,Rosbach),14.5 millimetresinlengthandwithadiameterof5.3mil- limetres, was inserted and the insertion aid was re- moved (Figs. 6 & 7). To compensate for the loss in bone height in the crestal region, an augmentation wascarriedoutusingBioOss(Geistlich)andcovered with the resorbable membrane, Osseoquest (W. L. Gore, Putzbrunn). The membrane was fixed in place using the implant's cover screw and the margins of the muco-periostal flap. The site of the operation was closed with 9 simple interrupted sutures (Fig. 8) after mobilization of the muco-periostal flap through periost slitting and a control X-ray was taken (Fig. 9). During the 6-month healing phase, a denture with a prosthetic tooth anchored with a clamp was worn (Fig. 10), which had been relined underneath with Flexor CC (Schütz Dental, Rosbach) to prevent any pressure on the site. Following healing (Fig. 11), the covering mucosa was opened with a semi-circular cut with a scalpel underlocalanaesthetic(Fig.12)andacylindricalgin- giva former, 2 mm in height, was inserted (Fig. 13). The X-ray shows an implant with good osseointe- gration (Fig. 14) and, to a large extent, maintenance and restoration of the gingival structures (Fig. 15). Only the papillary region between 21 and 22 is re- duced. The prosthetic treatment was conducted af- ter the gingival tissues had healed. The impression was made using Impregum (3M ESPE, Seefeld) and Fig. 9_OPG after implantation. Fig. 10_Temporary restoration with a removable denture. Fig. 11_Situation after healing process, seen from occlusal view. Fig. 12_After opening up. Fig. 13_Situation with the gingiva former. Fig. 14_Implant with good osseointegration. Fig. 15_Gingival situation after opening up. Fig. 16_Inserted impression post. Fig. 17_After taking the impression the model with gingiva mask is produced. Fig. 18_Adapted abutment. Fig. 19_Internal hexagon to prevent rotation. Fig. 20_Model of the crown. Fig. 21_Processed crown cap prior to application of the ceramic. Fig. 10 Fig. 12Fig. 11Fig. 9 Fig. 14 Fig. 16 Fig. 17Fig. 15Fig. 13 Fig. 18 Fig. 19 Fig. 20 Fig. 21