implants - international magazine of oral implantology

I industry report Fig. 20_Ceramic abutment cemented to a titanium base. Fig. 21_Definitive screw-retained abutment on the lab analog. Fig. 22_Splinting of the long-term temporary crown in region 11 with the crown on the natural stump. Fig. 23_Two days post-op. Fig. 24_Fixed long-term temporary crown. Fig. 25_Michigan splint to protect the surgical site from pressure. Fig. 26_Revision of the root-canal treatment in region 12. Fig. 27_Ceramic pin, fitted into the root canal and cemented in. Fig. 28_X-ray examination of the inserted ceramic pin. _Implant placement The metal pin was clearly visible on the apex of theremovedroot(Fig.7).Accuratemeasurementof the alveolar cavity is essential with immediate im- plant placement. This is the only way to find out where the bone is and whether it is intact. The im- plantdiameterwasmeasuredwithaverniercaliper (Zepf Medizintechnik, Fig. 8). The alveolar cavity was also probed with the periodontal probe to de- tect any defects on the alveolar margin. The gingi- val height was analyzed as well in order to allow an estimate of future resorption (Fig. 9). _Impression and temporary abutment The planned implant axis and the distances to neighboring structures can be checked with the form drill inserted into the alveolar cavity (Fig. 10). Figure 11 shows the insertion of a CAMLOG® SCREW-LINE Promote® implant 5 mm in diameter and 16 mm long. Impression-taking with an im- pression post and open tray followed for fabrica- tionofthe“earlyabutment”andlong-termtempo- rary crown (Fig. 12). Fig. 13 gives the details of the impressionforprecisetransferoftheimplantposi- tion to the master cast. The temporary shell crown was relined on an intraorally marked and labora- tory-customized titanium abutment. In low heights, titanium with its greater stability is more suitable than PEEK (Fig. 14). The temporary shell crown was positioned with the aid of an insertion key (Fig. 15). The labial gap between implant and alveolar cavity should be filled with a non-re- sorbable bone replacement material for bone and soft-tissue regeneration (Fig. 16). The soft tissue was compressed with a free subepithelial connec- tivetissuegraft.Apouchwaspreparedwithoutver- tical incision and without injuring the papillae (Fig. 17). _Early abutment and long-term temporary denture Figure 18 shows the connective tissue graft in situ;itisimportanttokeepthepapillaeintact.Inthe meantime, the provisional crown was trimmed in the laboratory; it can be cemented in after screw- ing in the titanium abutment (Fig. 19). A ceramic abutment cemented to a titanium base was fabri- cated within two days. The zirconium-oxide-ce- ramic has a smaller diameter for platform switch- ing (Fig. 20). Figure 21 depicts the definitive screw- retained abutment on the lab analog. The long-term temporary crown in region 11 was splinted with the crown on the natural stump (Fig.22).Twodayspost-op,thetemporarytitanium abutment was replaced with the definitive ceramic abutment (Fig. 23) and the long-term temporary 36 I implants3_2012 Fig. 24 Fig. 25Fig. 23 Fig. 20 Fig. 27 Fig. 28Fig. 26 Fig. 21 Fig. 22