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implants international magazine of oral implantology

I case report chronicmarginalperiodontitiswaswellcontrolledby asystematicperiodontaltreatment.Onlytheanterior teeth#12,11,21and22hadnotbeenpreservedprior to the medical intervention. Figures 2 and 3 illustrate the clinical situation prior to the implantological restoration of the eden- tulous space of teeth #12 to 22, approximately only fourandahalfmonthsafterthetoothextractiondue to severe periodontal pre-damages. A transversally atrophied Processus alveolaris appeared after the formation of the mucoperiosteal flap and the open- ing of the surgical area, featuring an alveolar ridge widthsufficientforimplantsofadiameterof4.5mm (Fig. 4). The verification and marking of the implant position are followed by the successive preparation of the cavities according to the well-known surgical protocol. Paralleling pins or paralleling tools can be applied to support the process already during pilot drilling in order to find an optimum axial direction andposition(Fig.5).Figures6and7demonstratethe problems of the transversally atrophied Processus alveolaris: The depth gauge in the implant cavity clearly depicts the measurable difference in the lev- els of the vestibular and the oral Pars compacta, amounting to approximately 1.5 mm. The implants areinsertedassoonastheconditioningoftheimplant bed with regard to the diameter has been completed. In principle, this procedure can be initially performed by machine and according to the dentist’s individual preferences. However, the final position must by all means be adjusted manually. The OsseoSpeed™ TX Profile implant is removed fromthesterilewrappingwiththehelpofanimplant driver. During the removal, a corresponding color markingmustbeadaptedtothechamferedsideofthe implant(Figs.8&9).Figure10showshowthefinead- justment of the implant position must be performed manuallybymeansofasurgicalratchetwrenchcon- nected to handle. In this way, the dentist can deter- minetheoptimalfinalimplantpositioningaccurately within a fraction of a millimeter (Fig. 11). The adjust- ment of the implant to a position most suitably adapted to the anatomical structures must therefore berealizedbytheapplicationoflightfingerforce.Vi- sual control from the optimum position shows the flush transition of the inserted OsseoSpeed™ TX Pro- fileimplanttotheadjacentboneoftheslightlyslant- ing alveolar process (Fig. 12). When this key position is achieved, the procedure can be continued accord- ing to the surgical standard protocol. Precisely con- figured closure screws were developed for this spe- cific implant design. They are taken from a blister in a sterile manner (Fig. 13). Figure 14 depicts an implant shoulderadjustedtotheanatomicalstructureswith- 22 I implants2_2012 Fig. 8 Fig. 9 Fig. 10 Fig. 11