implants - international magazine of oral implantology

I research 08 I implants4_2012 essential for the prevention of peri-implant cervical bone loss (Cochran et al. 2009; Mangano et al. 2009; Schwarz et al. 2008) because these micro-movements betweentheimplantandtheabutmentcouldleadtothe formationofamicro-gap(Racketal.2010),resultingin internal contamination of the implant (Jansen et al. 1997;Steinebrunneretal.2005). This case report is aimed at demonstrating the ad- vantagesofthedesignoftheMorsetaperimplant(Im- placilDeBortoli)formaintenanceoftheanatomyofthe peri-implanttissue. _Case presentation A 53-year-old male patient requested treatment of a coronal fracture of the right maxillary lateral incisor, which had been endodontically treated with a metal- ceramic crown with a metal core (Fig. 2). During surgi- cal planning, factors essential to treatment success were observed, among which was the maintenance of theproximalbonecrest,whichisessentialindetermin- ingtheprognosisoftheinterproximalpapillaoftheim- plants (Rack et al. 2010) and future difficulties rising from the adjacent tooth, the central incisor, which was aprosthesissupportedbyanimplant. Duringdrilling,itwasobservedthatthepocketdepth was less than 4 mm, since the fracture was fresh. After evaluating the patient’s need for immediate aesthetics and his general condition, we chose to extract the re- mainingrootandimmediateplacementoftheimplant and of the provisional. After anaesthesia, appropriate syndesmotomy was performed without displacement oftheincisionortissue,inordernottodisruptthegin- givallineandtokeepthepapillainpositioninseekingto prevent bone loss. This was achieved by performing an atraumaticextractionofthetooth(Fig.3a). Anosteotomywasthenperformedinordertoensure the ideal position of the implant with regard to the fu- turepositionoftheprosthesis(Fig.3b).Thesurgicalse- quence of the perforations followed the standard pro- tocol specified for the placement of tapered implants, paying attention to the mesiodistal and buccolingual positioningoftheimplant,whichshouldbearound1to 2 mm for the buccal palate in relation to neighbouring teeth. The osteotomy started with super sharp drill launches in the predetermined position towards the palatal wall of the socket, preserving the labial plate. Subsequently,weuseda2mmdrilltotheplanneddepth with a direction indicator to verify the need for adjust- ments in the orientation of the implant. This was fol- lowedbyconicaldrillsof3.5mmand4mm(Fig.3c).The selected implant was a tapered Morse cone implant of 4mmindiameterand13mminlength(ImplacilDeBor- toli). The implant was placed in the implant bed (Fig. 4a) manually using with a torque meter (Fig. 4b), position- ingtheimplantapproximately2mmbelowthelevelof thecentralbonecrestofthealveolarbone(Fig.4c).The crash was performed at a torque of 50 N cm. An abut- ment(3.5x4.5x4mm)wasimmediatelyplaced(Fig.5a). Figs. 4a–c_Image of implant being placed in the implant bed (a), its final position (b), and the probe marking about 2 mm below the level of the central alveolar bone crest of the tooth (c). Figs. 5a–c_The positioned abutment (a), diagram showing the dimensions of the measured values (b), and the seated provisional (c). Fig. 3c Fig. 4a Fig. 4b Fig. 4c Fig. 5a Fig. 5cFig. 5b