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implants - international magazine of oral implantology International Edition

industry report I by employing enamel matrix proteins (Straumann® Emdogain) in the sense of ’Socket Preservation‘ prior toimmediateimplantplacementat32and42(Fig.2). FromtheCone-BeamComputerTomogram(CBCT) it could already be presumed preoperatively that simultaneous augmentation in the sense of a less invasiveprocedurecouldbedispensedwithbyprecise implant placement at the soft tissue level, and that a four-unit fully functional porcelain-fused-to-metal bridge(PFM)couldbeinsertedwithoutdifficultiesdue tothemorestableimplantmaterial(Roxolid®). Surgicalprocedure. Followingperiodontalhealing(Fig.3),teeth32and 42couldeachbeextractedintotofromthehealthytis- sue without fracturing, in particular of the buccal lamellae. The clinical and radiological examination employing combined depth gauges showed a four- unitanteriorbridgetobepossibleunderthesecondi- tions(Figs.4–6).Therehadalsoneverbeentheneces- sityforsimultaneousboneaugmentation(Osteogenic JumpingDistance). UsingtheNNCprofiledrill,thecrestalbonewasex- panded minimally in the present type 2 bone prior to implantplacementofthetwo10mmNNCimplantsin eachcase(Ø3.3mmto3.5mm;Figs.7&8). Attention was paid during the implant placement of the two NNC implants, that the Microgap could be placed precisely 2 mm coronal of the buccal limbus alveolaris, so as not to obtain crestal bone or soft tis- suelossfollowingappropriatetissuematuration(Tis- sue-directed Implant Placement1, 2 ; Figs. 9–11). The new NNC insertion device enables perfect aesthetic analysisoftheinsertiondepthinrelationtothevariable thickness of the periimplant gingiva (Biologic Width: 2.25–3.75 mm1, 2 ) and can be fixated again in the im- plant at any time for fine adjustment prior to suturing due to the tapered press-fit design (Fig. 12), which al- lowsobtaininganoptimal,biocompatibleintrasulcular position of the Microgap following complete healing andremodeling. Duringthefinalalignmentoftheimplants,onethen needstoagainensurethatthesemi-sphericalrecesses ontheinsertiondevicesareplacedpreciselyinbuccaldi- rection, so that the prosthetic abutment components canbealignedpreciselylateron.Using3mmNNCheal- ingcaps(Figs.13&14)providesidealconditionsforsoft tissue maturation (up to six months) in combination withanappropriatetemporaryrestoration(Fig.15).This also dispenses with the need for a second surgical in- tervention(uncovery). Prostheticprocedure The base of the temporary prosthetic restoration, whichshouldbesupportedocclusally(Fig.15),mustnot touch the healing caps statically and functionally dur- ing initial healing. This can be checked with a silicone paste(FitChecker®). Fivemonthspostimplantationem theBiologicalWidth1,2 hasbecomeperfectlyestablished inthehealthymouth(seecomparisonFigs.13&16).Us- ingascrew-retained,openimplantimpression(Fig.17) it was possible to fabricate the 4-unit PFM bridge 32xx42withgreatprecision(Fig.18*),whichallowedan adequate outcome in terms of hygiene, chewing com- fort,aestheticsandphonetics(Fig.19).Hereitisrecom- mended to communicate the exact dimensions of the individually determined interdental tooth brushes (Fig. 19),whicharetobetestedinvivoonthepatientandre- Figs. 7 & 8_New NNC crestal profile drill adjustment. Figs. 9–11_Tissue-directed Implant Placement.1,2 Fig. 12_New NNC press-fit insertion devices. I 39implants4_2013 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12