Dental Tribune United Kingdom Edition

January 16-22, 201220 Implant Tribune United Kingdom Edition OsseoSpeed™ TX Profile – anatomically designed implants for sloped ridges Imagine being able to achieve 360° bone preservation around the implant, even in cases with sloped ridges. Now you can. With OsseoSpeed™ TX Profile – a uniquely shaped, patented implant, specifically designed for sloped ridge situations – you no longer have to choose between buccal and lingual marginal bone preservation and aesthetics, you can have it all – 360° around the implant. As with all Astra Tech implants, OsseoSpeed™ TX Profile is based on the documented key features and benefits of the Astra Tech BioManagement Complex™. Used in combination with patient-specific Atlantis™ abutments, you and your patients can look forward to long-term function and aesthetics. For more information, please visit www.astratechdental.co.uk 79436-GB-1103©2011AstraTech Astra Tech, Brunel Way, Stonehouse, Glos. GL10 3SX. Tel: 0845 450 0586. Fax: 01453 791001, www.astratechdental.co.uk Adapting with nature sible to determine the implant length and suitable diameter preoperatively. During extraction with a periotome, great care was taken not to traumatise the hard or soft tissue unnecessar- ily (Fig. 3). Soft-tissue detach- ment was thus avoided. The tooth socket was then probed, revealing an intact buccal la- mella (Fig. 4). The granulation tissue present was removed. There was no sign of acute in- flammation. Figure 5 shows the size relationship of the extract- ed root remnants to the im- plant (Replace Select Tapered, Regular Platform 4.3 × 10mm, Nobel Biocare). Figure 6 shows the implant inserted in its final position. The implant shoulder in the buccal direction was ap- proximately 1 mm sub-crestal (see also Fig. 7) with a buccally oriented channel of the inter- nal connector (Fig. 6). The palatally displaced im- plant position, resulting in a safety distance of up to 2mm to the buccal wall (bone jump- ing distance), can also be seen in Figure 6. Following implan- tation, the gap was augment- ed with a mixture of Bio-Oss (Geistlich) and endogenous bone. Endogenous bone was removed from the left tuber re- gion with a bone scraper. A cov- ering membrane was not used. The follow-up radiograph (Fig. 7) shows the correct distances to the neighbouring teeth and the vertical position, corre- sponding approximately to that of the extracted root (cf. Fig. 2). The shape of the implant also closely matches the coni- cal root shape. In this way, it is possible to avoid perforation of the facial alveolar wall, es- pecially in patients with thin buccal bone. For this reason, the pilot hole should always be drilled palatally to the natural root tip, and expansion holes should be drilled while exert- ing pressure in the palatal di- rection. The area was prepared in accordance with the stand- ard protocol. The implant was then inserted with a torque of 35 Ncm. With this primary sta- bility achieved, the most im- portant requirement for imme- diate loading was met. Because the patient wanted an immedi- ate highquality aesthetic res- toration, fitting a laboratory- fashioned temporary crown of composite material was planned. An open impression was taken with a custom tray (Fig. 8). In order to minimise the laboratory time required, the implant position was trans- ferred to the original model by means of a plastic key (Pat- tern Resin, GC Europe). The titanium abutment used for the temporary crown (Esthetic Abutment) is characterised by scalloped edges that follow the softtissue contours and provide support (Fig. 9). In order to achieve further optimisation, the abutment was custom- made by the dental technician. However, it was still possible to make fine adjustments in situ with the help of rotating car- bide-tipped instruments. Just 24 hours after implan- tation, the custom abutment and the temporary compos- ite crown were fitted (Figs. 9 & 10). Correct seating of the abutment on the implant was checked with the help of a den- tal radiograph (cf. Fig. 7). Care was taken when fashioning the crown to avoid static or dy- namic contact points. This was rechecked in situ. The crown was then fixed in place with temporary cement (TempBond, Kerr Dental). The patient was also instructed to exert as lit- tle pressure as possible on the crown when eating. Three months later, after a new impression had been tak- en, a custom Procera Esthetic Abutment (Nobel Biocare) was screwed into place, and the final full ceramic CAD/CAM crown was fixed using glas- sionomer cement (Fig. 10). The Periotest score for the implant was very good at this stage (-7). Result and prognosis Despite the recession and less than optimum fit of the restora- tions of the neighbouring teeth, page 19DTß ‘During extraction with a periotome, great care was taken not to trau- matise the hard or soft tissue unneces- sarily’