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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
I industry report Fig. 17_Implants connection area covered with a colour coded cover screw. Figs. 18 & 19_ISQ measures. Fig. 20_Removal of fractured tooth (27) and the surrounding granulation tissue. positions25and26.Insteadofguidedboneregen- eration with an autogenous bone block or xeno- geneic bone substitute material covered with a collagen membrane, a crestal expansion with threaded osteotomes was proposed. Also, it was decidedtouseBEGOSemadosRSXimplants(BEGO ImplantSystems)becauseoftheirmacroscopicta- pered design and high self-tapping property. _Clinical case A 60-year-old non-smoking female patient withoutanynoteworthyclinicalpathologyorcur- rent drug treatment came to our clinic reporting pain and swelling in tooth 27, which was a sup- portingelementofabridgeonteeth24–27(Fig.2). A root fracture with a large apical cyst affecting the three roots of the molar was observed on a CBCT scan (Fig. 3). Based on this finding, the fol- lowing treatment plan was proposed to the pa- tient: 1) extraction of tooth 27 with cyst removal; 2) bone regeneration of the area using a xenograft particulate bone substitute material (BEGO OSS, BEGO Implant Systems), covered with a re- sorbable collagen membrane (BEGO Collagen Membrane, BEGO Implant Systems); 3) replacement of teeth 25 and 26 using two im- plants (BEGO Semados RSX) and bone expan- sion; 4) seating of a full lithium disilicate ceramic crown (IPS e.max, Ivoclar Vivadent) on tooth 24 fabri- cated with the CEREC system (Sirona Dental) in the clinic on the same day of the surgery; 5) seating of full lithium disilicate ceramic crowns (also IPS e.max) on the implants placed in re- gions 25 and 26 three months after the surgery. After removal of the old fixed prosthesis, and before starting the surgery, tooth 24 was prepared (Fig. 4) and a digital image captured (Fig. 5). Thus, the lithium disilicate ceramic crown could be de- signedandfabricatedwiththeCERECsystemwhile the implant surgery was performed. Finally, the crown could be cemented at the end of surgery. In order to start the surgery, a full-thickness mu- coperiosteal flap with a mesial vent for papilla preservation was raised (Figs. 6–8). Threadedosteotomeswereusedaftertheinitial drilling (Figs. 9–11), taking into account the trans- verse bone loss that existed in the area, as well as the emergence profile of the implant and the fu- ture prosthesis. This step had two aims: good 3-D location of the implant and bone condensation, which would improve the bone quality in the re- ceiving area (Fig. 12). For this clinical case, it was necessary to use an implant that could be easily and atraumatically in- serted in order to prevent a greenstick fracture of the buccal cortical wall. Owing to their tapered body design and high self-tapping property, two BEGO Semados RSX implants were selected (Figs. 13–15). This implant was also selected because of 38 I implants3_2014 Fig. 17 Fig. 18 Fig. 19 Fig. 20