Dental Tribune United Kingdom Edition

May 21-27, 201216 Cosmetic Tribune United Kingdom Edition A female student of 20 years of age was re- ferred for a consulta- tion regarding replacement of her failing resin bonded bridge (Fig 1). She gave a his- tory of having congenital ab- sence of the maxillary right lateral incisor tooth. Fixed appliance orthodontic treat- ment had been used to create adequate mesio distal space for a bridge pontic. The space measured 7.5mm. There was a deficiency of the labial plate in the 12 site and the patient complained of a dark appearance at the gin- gival zenith of the bridge pon- tic. The bridge had repeatedly de-cemented and had a poor fit where excess cement was present and possible procli- nation of the bridge retaining tooth 11 had occurred (Fig 2). Treatment options were discussed, including a fur- ther resin bonded bridge, a removable partial denture or an implant retained crown. Poor long-term success rates for resin-bonded bridges with failure rates of up to 75 per cent after six years can be ex- pected.1 The patient and her par- ents decided to proceed with the implant option. Initially study casts were fabricated and an in-house cone beam CT scan undertake (Gendex i Cat) to achieve a 3D image of the proposed implant recipient site. The scanned zone was minimised to reduce the radiographic exposure to the patient. The scan result confirmed a narrow ridge, but adequate width for placement of a nar- row platform 3.5mm diameter NobelReplace Tapered Groovy implant with simultaneous guided bone regeneration us- ing a xenograft (Bio-Oss and Biogide Membrane) (Fig 3). We planned to use the new NobelReplace Tapered Groovy implant with a conical connec- tion. This is a combination of the successful Replace implant with a different platform con- nection based on the NobelAc- tive implant, which is designed to provide a tight coronal seal and a platform shift which gives good aesthetic results by reducing the microgap. With a platform shift con- cept, designers aim to move the implant abutment inter- face away from the periphery of the implant thus attempting to maintain good bone levels. When possible, it is intended to place the conical connection implant slightly sub-crestal to allow bone deposition coronal to the implant platform. I find the NobelReplace Ta- pered Groovy Implant easy to place and have confidence in achieving good primary sta- bility with the tapered implant profile. A surgical guide was fab- ricated to allow angulation of the implant for a screw re- tained crown. Whenever pos- sible, I use screw retained crowns to prevent the neces- sity of cement with the poten- tial risk of cement extrusion on cementation and also to fa- cilitate retrievability. A crestal incison with buc- cal flap elevation with no re- lieving incisions was used to minimise the risk of compro- mising the blood supply to the mucoperiosteum. Confirma- tion of a narrow ridge was made and osteotomy prepara- tion undertaken up to 3.5mm diameter and 10mm length (Fig 6). A Nobel Replace Tapered Conical Connection implant was inserted at 35Ncm torque achieving good primary sta- bility. The coronal 2.0mm of A new connection Fig 1 Fig 2 ‘I find the NobelReplace Tapered Groovy Implant easy to place and have confidence in achieving good primary stability with the tapered implant profile’ Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 Fig 8 Philip Pettemerides presents a case using the new Nobel Biocare conical connection implant