implants - international magazine of oral implantology

I case report Fig. 11_Patient-specific abutment prior to insertion. Fig. 12_Complete individualised crown restoration on master cast. Fig. 13_Abutment insertion and mounting with a torque wrench at 25 Ncm. Fig. 14_Occlusal view of the inserted abutment. Fig. 15_Closing of the screw opening with Cavit (3M ESPE) prior to cement- ing the superstructure. with Zahntechnik Zentrum Eisenach after the tooth replacement was firmly in place, despite alveolar bone loss and difficult gingival conditions (Figs. 1 & 2).Thesurgicalprocedureforthiscaseisdescribedin Liebaug and Wu (2011).5 The anatomically formed and bevelled Osseo- Speed TX Profile implants (DENTSPLY Implants) were used in regions #12, 11, 21 and 22. These im- plants are specially designed to preserve the mar- ginalboneinanalveolarridgewithangularatrophy both vestibularly and orally, that is, 360 degrees aroundtheimplant.6 Restorationwithpatient-spe- cific ATLANTIS abutments (DENTSPLY Implants) was planned in order to complete prosthetic restorationoptimallyaftersuccessfulimplantation and osseointegration. As described in Noelken (2011),7 themarginalbonecanbepreservedcheaply by the use of these implants, which are new to the dental market. Optimal soft-tissue support can be achieved with individualised manufactured abut- ments. _Challenge in terms of maxillary anterior tooth loss Whilereplacingamissingtoothwithanimplant cannowbeconsideredroutine,rehabilitationinthe maxillary anterior region still represents a particu- lar challenge for the treatment team. In addition to successful osseointegration of the implant, partic- ularattentionmustbegiventofunctionalandaes- theticparameterstoachievearestorationthatper- fectly harmonises with natural teeth.8 _Prior to surgery: Addressing the patient’s wishes and providing information The patient’s wishes must always be considered before treatment begins. The patient should be of- feredclarificationpriortotreatment,particularlyin difficult initial situations with evident hard-tissue loss and unfavourable gingival conditions. For forensic reasons, photographic documentation of the initial situation is an indispensable aid in addi- tiontodiagnosticcasts.Itshouldalsobeusedasthe basis for discussion with the patient. Ifboneonthelabialsidehasalreadybeenlostand the optimal bone contours have not been restored with a bone transplant, achieving the desired aes- thetic result is nevertheless often not difficult. Intermsofthis67-year-oldpatient,theimplants were exposed by incision to the middle of the alve- olar ridge from regions #12, 11, 21 and 22 after a four-month healing phase (Fig. 3). Itshouldbenotedthat,owingtothebevelledde- signoftheimplantsused,analmostseamlessinser- tion into the natural osseous alveolar process is achieved,andthustheplasticcoverandtheprimary woundclosurearesimplifiedforthesurgeon.Thisis also the basis for a quick and smooth healing process. Three-dimensional bone structures can be pre- served using the above-mentioned OsseoSpeed TX 30 I implants4_2012 Fig. 11 Fig. 12 Fig. 13 Fig. 15Fig. 14