implants - international magazine of oral implantology International Edition

I industry report Fig. 28_The Esthomic abutment, extended with a bonding aid, shows the palatal positioning of the access channel. Fig. 29_Customising the primary abutment ensures sufficient coating strength of the zirconium oxide abutment. Fig. 30_The titanium base and the completed model of the secondary abutment were scanned in the laboratory. Buccal space was left for the planned pressed ceramic veneer. Fig. 31_The sintered abutment left without and right with fluorescent solution treatment. Fig. 32_Firing of a highly fluorescent, etchable zirconium oxide veneer ceramic. The shape of the abutment was optimised prior to modelling the press cap. Fig. 33_The layer thicknesses for veneering the pressed ceramic caps were checked with the aid of the vestibular, twice-divided silicone index. again with piezo-surgery, a sharp lever and dia- mondpliers.Thisrevealedthatthethinbuccalbone lamella was connected to the root (Fig. 5). The os- seous margin of the alveolus was examined care- fully with a periodontal probe (bone sounding). Despite a lack of bone wall, an immediate im- plantationasplannedwastobeperformedaccord- ing to the protocol of the University Medical Cen- teroftheJohannesGutenbergUniversityofMainz.8 Withtheaidoftheguidepreparedinthelaboratory; the positions were marked prior to preparing the implantbed(Fig.6).Pilotdrillingandfurtherdrilling steps were performed by the surgeon without a guide and with drill extension for optimal cooling. Insertion of the implant (CONELOG, CAMLOG; 3.8 mm diameter, 13 mm length) was also per- formed without a guide (Fig. 7). Correct 3-D orientation of the implant was checkedwiththefinaldrillandusingthedrillguide. The buccal implant shoulder should be 3 mm apical of the marginal soft tissue and distinctly palatal to the dental arch (Figs. 8 & 9). This ensures that the subsequent implant-supported crown can be screwed in palatally. The gap between the implant andbuccalsofttissuewasfilledwithbonematerial. This was a mixture of autologous bone gained dur- ing preparation. Granular autologous bone har- vested from the retromolar area and bovine bone augmentation material were used to prevent re- sorption (Figs. 10 & 11). In order to obtain the best possible soft-tissue conditions in the sense of a thicker gingival type, the surgeon harvested a connective-tissue graft from the palate. Using the tunnel technique ac- cording to Azzi,9–11 this was pulled between the bone granulate and the buccal soft tissue and fixed with a monofilament, non-absorbable suture ma- terial (Fig. 12). Then a CONELOG wide-body healing cap (4 mm height) was screwed in and the tempo- rary bridge cemented (Fig. 13). This supported the soft tissue, but did not contact the healing cap, so that the lower section of the pontic could be cleaned with super floss. Figures 14 and 15 show the post-operative X-ray and the situation at the check-up one week after immediate implantation. After three months of implant healing, the peri- implant and periodontal tissues were ready for fi- nal impression taking (Figs. 16 & 17). To this end, double 0 sutures soaked in glycerine were placed in the sulci and the preparation borders placed slightly subgingivally as part of final fine prepara- tion. Then a thicker retraction cord, strength 0, soaked in epinephrine was placed (adrenaline; Fig. 18). The healing cap was unscrewed (Fig. 18) and a CONELOG impression post for open trays screwed in (Fig. 19). Impression taking was performed after dryingandremovalofthethickretractioncord(Fig. 19) in one step with an individual open tray and a two-phase polyvinyl siloxane (A-silicone). Follow- ing arbitrary transfer of the occlusal relations with a bite fork, facebow and bite registry, the healing caps and temporary bridge were reinserted. A tem- 28 I implants1_2014 Fig. 31 Fig. 33Fig. 32 Fig. 28 Fig. 30Fig. 29