cone beam international magazine of cone beam dentistry

34 I I case report _ CBCT in implant dentistry Owing to the patient’s previous periodontal his- tory, it was decided to use Standard Plus implants (Straumann) in this case. The design of this implant incorporates a 1.8 mm polished collar above the active surface of the implant. This results in the im- plant-to-abutment junction being located 1.8 mm superiorly to the bone crest. _Surgical procedure The patient was given 400 mg ibuprofen and a chlorhexidinemouthrinsebeforethesurgerybegan. The procedure was carried out under intravenous sedation using midazolam. The lower incisors were removed using peri- otomes and forceps. The sockets were curetted and thoroughly irrigated. A crestal incision with distal relievingincisionswasmade.OwingtotheCBCTscan andsurgicalstent,onlyasmalllingualreflectionwas necessary. Implant placement was carried out using stan- dard ITI protocols. Two SLActive Standard Plus im- plants (4.1 x 10 mm; Straumann) were placed. The implants exhibited excellent primary stability with an insertion torque of greater than 35 Ncm. The patient’sbonequalitywasestimatedtobetypeD1–2 (Lekholm & Zarb 1985). Owingtothehighprimarystabilityandgoodbone quality, it was decided to adopt a single-stage sur- gical protocol, thereby placing healing abutments over the implants. The site was closed using 5-0 PGA sutures and a tooth-supported denture replacing the lower incisors was fitted. Careful examination of the denture was carried out to ensure there was no contact,ortransferofocclusalloadontotheimplants from the denture. The patient was seen seven days after surgery for suture removal and review. Thepatienthealedwithoutincidentandowingto the favourable lingual undercuts of the lower teeth was able to wear the denture comfortably during the healing process. Owing to financial reasons, the planned implant placement for the tooth #14 site was deferred until a later date. After eight weeks of healing, fixture-level open- trayimpressionsweretakeninImpregum(3MESPE), and a four-unit screw-retained bridge was fabri- cated. The tooth set for the denture was duplicated onthefinalbridge,asthepatientwashappywiththe toothsizeandshape.Owingtothepreviousboneloss, pink porcelain was added to the bridge to improve the emergence profile and reduce the crown lengths of the lower incisors. The bridge was seated and torqued to 35 Ncm and composite placed in the access holes. A baseline long-cone periapical radiograph was taken to serve as a baseline for bone-level measurements. The oc- clusion was checked, with the patient exhibiting ca- nine guidance in excursive movements. The patient was shown how to clean under the bridge using su- perflossandTePebrushesandplacedonalong-term maintenance programme. _Prognosis Thebridgehasagoodlong-termprognosis,asthis patient is highly motivated, and exhibits excellent oral hygiene. She is aware of the increased risk of complications, and the possibility of losing more teethinthelongrun,butafterhavingwornadenture for three months, she is determined to avoid be- coming a long-term denture wearer. The patient will see me at six-monthly intervals and sees a hygienist every three months for maintenance._ Fig. 14_After eight weeks of healing. Fig. 15_Insertion of final bridge. Figs. 16 & 17_Appearance at one month review. cone beam1_2014 Dr Nilesh R.Parmar was voted BestYoung Dentist in the East of England in 2009 and runner up in 2010. He was shortlisted at the Private DentistryAwards in the category of Outstanding Individual 2011 and received Highly Commended for Best Dentist South at the 2013 DentalAwards.Dr Parmar offers training and mentoring to dentists starting out in implant dentistry,more information can be found on his website www.drnileshparmar.com. Twitter:@NileshRParmar. Facebook:DR NILESH R.PARMAR cone beam_about the author Fig. 16 Fig. 17 Fig. 14 Fig. 15 CBE0114_32-34_Parmar 31.01.14 15:52 Seite 3