implants - international magazine of oral implantology

_Case presentation: Patient 1 A30-year-oldfemalepatientwithoutmedicalcon- tra-indication for implant therapy presented with a congenitally missing maxillary right lateral incisor. The clinical and radiographic examination demonstrated that the patient was a good candidate for Trabecular Metal implant placement and restoration (Fig. 1). The patientwasgiventheoptionofimplantplacementand immediate non-occlusal loading as an alternative to a stagedapproachiftheimplantdidnotachievegoodpri- marystability. Surgicaltreatment At the surgical appointment, following administra- tion of local anaesthesia, a full thickness flap was re- flected. The osteotomy was performed using a pointed starter drill, followed by a 2.3 mm twist drill. It was de- terminedthatthebonedensitywasD2–3.Usingasoft- bonedrillingprotocol,6–7 thenextdrillwasused.Nobone tap drills were used in order to ensure implant stability (Fig.2).Thefixturetransfercopingwaspreparedtosup- port a non-functional provisional crown. The deficient alveolarridgewasaugmentedusinganallograft(Puros Cortico–CancellousParticulateAllograft,ZimmerDen- tal—a mix of 70% cortical bone and 30% cancellous bone; Figs. 5 & 6). After implant placement, the patient wasgivenpost-surgicalinstructions,includingtheuse of 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) three times a day and was prescribed 500mg of amoxicillin (every six hours for seven days).The pa- tient was seen for a follow-up visit ten days later and healingwasuneventful(Fig.7). Prosthetictreatment After allowing the soft tissue to mature for four weeks,thefinalfixture-levelimpressionwastakenand a final cast custom abutment was used to support a porcelain-fused-to-metalcrown(Fig.8). Follow-upandmaintenance Aftersixmonths,thepatientreturnedforafollow-up visit. The clinical and radiographic exam demonstrated thattheimplantationhadbeenagreatsuccess(Figs.9& 10). The patient was placed on a six-month recall to maintaintheimplantandtherestorationproperly. _Case presentation: Patient 2 A 65-year-old male patient without medical con- tra-indication for implant therapy presented with a fractured maxillary right central incisor. The clinical andradiographicexaminationdemonstratedthatthe patientwasagoodcandidatefortheextractionofthe toothandimmediateimplantplacement(Fig.11).The patient was given the option of immediate implant placementandimmediatenon-occlusalloadingasan alternativetoastagedapproachiftheimplantdidnot achieve primary stability at > 35Ncm insertion torque. Surgicaltreatment Atthesurgicalappointment,followingadministra- tionoflocalanaesthesia,aflapless,atraumaticextrac- tion of the maxillary right central incisor was per- formed using periotomes. The osteotomy was per- formed using a pointed starter drill, followed by a 2.3 mm twist drill. It was determined that the bone quality was D2–3. Using a soft-bone drilling protocol, thenextdrillusedwas2.8,2.8/3.4x13mm.Nobonetap drillswereusedinordertoensureimplantstability(Fig. 12). A Trabecular Metal implant of 4.1 mm in diameter and13mminlengthwasinserted.Theinsertiontorque exceeded 35 Ncm (Figs. 13 & 14). The fixture transfer copingwaspreparedtosupportanon-functionalpro- visionalcrown.Thecriticalgapbetweentheextraction socket and the implant was grafted using an allograft (Puros Cortico–Cancellous Particulate Allograft; Figs.15&16). Prosthetictreatment After allowing the soft tissue to mature for four weeks,thefinalfixture-levelimpressionwastakenand a final cast custom abutment was used to support a porcelain-fused-to-metalcrown(Fig.17). Follow-upandmaintenance Aftersixmonths,thepatientreturnedforafollow- up visit. The clinical and radiographic exam demon- stratedthattheimplantationhadbeenagreatsuccess (Figs. 18 & 19). The patient was placed on a six-month recall to maintain the implant and the restoration properly. I case report Fig. 14_A Trabecular Metal implant placed in the extraction socket. Fig. 15_Prepared transfer coping with Puros Cortico–Cancellous Particulate Allograft filling the critical gap. Fig. 16_Non-occluding provisional restoration at the time of implant placement. 30 I implants1_2013 Fig. 15 Fig. 16Fig. 14