implants - the journal of oral implantology UK Edition

28 I I clinical _ CBCT implants1_2012 with very little lingual concavity. Due to the good bone height, and minimal pathology, im- mediate implant placement was planned. Due to the patient’s bone loss the lower incisors had drifted, giving a less than desir- able tooth position. One of the patient’s main complaints was the gaps which had appeared between the lower incisors and the uneven ap- pearance of the incisal edges. To aid implant placement in the correct an- gulation, a Cerec Blu-Cam image was taken and manipulated so that the lower tooth po- sitions were in harmony with the rest of the dentition. This proposal was then overlaid onto the CBCT scan and was used to facilitate im- plant planning. The aim was to provide the pa- tient with a screw retained bridge with access holes though the lingual aspects of the lower incisors, whilst maintaining a sound margin of safety from the lingual cortical plate. Due to the patients previous periodontal history, it was decided to use Straumann Stan- dard plus implant in this case. The design of this implant incorporates a 1.8mm polished collar above the active surface of the implant. This results in the implant-to-abutment junc- tion being located 1.8mm superiorly to the bone crest. _Surgical procedure The patient was given 400mg Ibuprofen and a Chlorhexidine mouth rinse before the surgery began. The procedure was carried out under intra-venous sedation using Midazolam. The lower incisors were removed using periotomes and forceps. The sockets were cu- retted and thoroughly irrigated. A crestal inci- sion with distal relieving incisions was made. Due to the CBCT and surgical stent only a small lingual reflection was necessary. Implant placement was carried out using standard ITI protocols. Two Straumann SLA- Active standard plus implants of 4.1 x 10mm were placed. The implants exhibited excellent primary stability with an insertion torque of greater than 35Ncm. The patients’ bone qual- ity was estimated to be type D1-2 (Lekholm & Zarb 1985). Due to the high primary stability Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig 5_Stage 1 implant placements with healing abutments in place . Figs 6+7_Presentation at 8 weeks