implants - international magazine of oral implantology International Edition

industry report I _Surgical procedure First,Iexposedtheboneusingascalpelandasharp curette. Because this case deals with a D4 bone, I de- cidedtouseanIMPLACylindricalimplantfromSchütz Dental. Thanks to the cylindrical structure and espe- cially coordinated thread sides, this implant offers a high primary stability in cases such as this one (Figs. 2–4). Thanks to the self-tapping thread of IMPLA Cylin- dricalimplant,Ionlyhadtoapplythepilotandexten- sion drilling techniques. With the help of the acrylic insertion aid and "no-touch" technology, I could in- sertandscrewtheimplantsquicklyandeasilyintothe drill holes (Figs. 5–7). After taking off the insertion posts and screwing on the healing caps, the mucous membrane was fit- ted with several 4.0 interrupted sutures (Ethicon, braided silk, non-absorbable, Fig. 8). While I was exposing the bone in position 12, I noticed that the available bone structure would not be sufficient (Fig. 9). Here, I chose an augmentative bone construction using the bone augmentation material CERASORB from the company Riemser as well as a resorbable Epiguide membrane. After I inserted the implant and screwed on the healing cap, I remodelled the bone structure using bone augmentation material. This made sure that the neck of the implant wouldn’t be seen after surgery (Figs. 10–13). After inserting the implants and removing the insertion posts, the im- plants were sealed with the healing caps. While treating the lower jaw, I came across a D1 bone.Onceagain,IchosetousetheIMPLACylindrical implant,onlythistimeforitsself-tappingproperties. Thismadethescrewinginoftheimplantsomucheas- ier in such compact bone as this (Figs. 14 and 15). The postsurgical panorama X-ray shows the situation with the inserted implants (Fig. 16). _Implant prosthetics In September of 2013, six months after implanta- tion,theimplantsintheupperandlowerjawwereex- posed. Then, the appropriate gingiva formers in gin- giva heights 2 and 3 were inserted (Figs. 17 and 18). Subsequently, alginate impressions were taken to produce plaster models and individual impression trays.Theindividualimpressiontraysweretoservefor individualimpressionswithimpressionpostsandthe posts21and23tobeprepared.Theformingpostsand according inner screws for the impressions were un- screweddirectlyafterremovingthemfromthepack- age (Figs. 19–21). Afterwards, an extensive function analysis and function diagnostics were performed. At our own lab, the necessary models were pro- duced from the impressions, taking into account the results of the function diagnostics. Next, the models were articulated. Finally, the designated abutment were screwed onto the model and worked on (Figs. 22–26). During the next session, the implant abutments and the framework were fitted intraorally. The fit of the abutments was additionally documented by and checked with a panorama X-ray (Fig. 27, panorama X-raywithabutments).Atalaterdate,theabutments were screwed in permanently and the openings were covered with Cavit. The restoration was set in for a test period of two weeks. At the end of September, the restoration was permanently fixed (Figs. 28–30). Finally,apanoramaX-raywastakenfordocumen- tation and to check the result (Fig. 31). _Conclusion Whendealingwithmajortoothlossafteragener- alised aggressive periodontitis, implant-supported individual crowns are an excellent solution, as they offerthepatientoptimalpossibilitiesfororalhygiene. First, however, a complex and tedious pre-treatment phase is necessary, as only a highly motivated and contributory patient, who will show up to each fol- low-upcaresession,canavoidarecidivismandcom- plications of peri implantitis in the long run._ Fig. 31_Panoramic X-ray of the final result. I 37implants4_2013 Dr Dr Philipp Plugmann,MSc MSc MBA Doctor of Dental Medicine (DMD) Master of Science Periodontology and ImplantTherapy (DGParo) Ludwig-Erhard-Platz 1 51373 Leverkusen,Germany _contact implants Fig. 31