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implants - international magazine of oral implantology

_Case presentation: Patient 3 A70-year-oldmalepatientwithoutmedicalcontra- indication for implant therapy presented with a frac- turedmaxillaryleftsecondpremolar.Theclinicalandra- diographicexaminationdemonstratedthatthepatient wasagoodcandidatefortheextractionofthetoothand immediateimplantplacement(Fig.20).Thepatientwas given the option of immediate implant placement and immediate non-occlusal loading as an alternative to a stagedapproachiftheimplantdidnotachieveprimary stabilityat>35Ncminsertiontorque. Surgicaltreatment At the surgical appointment, following administra- tion of local anaesthesia, a flapless, atraumatic extrac- tion of the maxillary left second premolar was per- formed using periotomes (Fig. 21). The osteotomy was performed using a pointed starter drill, followed by a 2.3mmtwistdrill.Duetomaxillarysinusproximity,asi- nus crestal approach (Sinus Crestal Approach Kit, Zim- mer Dental) was followed first to gain more space api- cally for the placement of a longer implant. It was de- terminedthatthebonequalitywasD2–3.Usingasoft- bonedrillingprotocol,thenextdrillusedwas2.8,2.8/3.4 x13mm.Nobonetapdrillswereusedinordertoensure implantstability.ATrabecularMetalimplantof4.1mm in diameter and 13 mm in length was inserted. The in- sertiontorqueexceeded35Ncm(Figs.22&23).Thecrit- icalgapbetweentheextractionsocketandtheimplant was grafted using allograft (Puros Cortico–Cancellous Particulate Allograft; Fig. 24). The fixture transfer cop- ing was prepared to support a non-functional screw- retained provisional crown (Fig. 25). The patient was given post-surgical instructions, including the use of 0.12% chlorhexidine gluconate (Peridex) three times a dayandwasprescribed500mgofamoxicillin(everysix hoursforsevendays).Thepatientwasseenforafollow- up visit 14 days later and healing was uneventful (Fig.26). 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.27). Follow-upandmaintenance Aftersixmonths,thepatientreturnedforafollow- up visit. The clinical and radiographic exam showed thattheimplantationhadbeenagreatsuccess(Fig.28). The patient was placed on a six-month recall to main- taintheimplantandtherestorationproperly. _Clinical relevance Withhigherdemandbypatientsforimmediateim- plantplacementandimmediateloading,theuseofta- pered implants that provide a high degree of primary stabilityandtheadditionoftheTrabecularMetaltech- nology provides faster secondary stability through bone in-growth, and can help achieve quick and pre- dictablefinalrestorations. _Conclusion Forty Trabecular Metal TMT, TMM implants were placed.Duringsurgery,aninsertiontorqueof>35Ncm wasusedin90%oftheimplants,and85%wereplaced at the crest of bone. Fifteen implants received provi- sionalrestorationatthetimeofplacement.Fullyfunc- tionaloccludingfinalrestorationswereseatedasearly as two weeks in 18 implants and as long as twelve weeks in the remaining twelve implants. After six months, 30 Trabecular Metal implants had been suc- cessfullyrestoredwithnosignsofimplantfailure._ I case report Fig. 27_The final restoration six months post-implant placement. Fig. 28_The radiograph six months post-implant placement shows the stable bone level around the apical and coronal aspects. Editorialnote:Alistof referencesisavailablefrom thepublisher. 32 I implants1_2013 Dr Suheil M.Boutros Periodontal Specialists of Grand Blanc Suite 19,8185 Holly Rd. Grand Blanc MI 48439,USA www.PeriodonticsOnline.com _contact implants Fig. 28Fig. 27