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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
I 15 case report _ CBCT in dental implantology I cone beam4_2014 A pre-surgical radiograph revealed root of tooth 21 to be resorbing, with apical radiolucency at 11 (Figs.2a&b).Afterextractionoftooth21,resorption of the socket wall was evident (Fig. 3). Therefore, a graft with bone substitute material and coverage with a membrane was performed (Fig. 4) to prevent collapseofthebuccalplate.Thewoundwassutured and a laboratory-made four-unit temporary re- storation was delivered (Fig. 5). One year was allowed for post-graft healing, as well as to allow for decompression of the radicular cyst. At the one-year follow-up, the soft tissue appeared healthy (Fig. 6). Figure 7 shows the virtual placement of a 4.8 mm x 13 mm OsseoSpeed EV implant, as viewed in a cone-beam computerised tomographic (CBCT) scan using the SIMPLANT software. The implant was placed utilising a flapless ap- proachanda4.8Ø6.5mmHealDesignEVabutment wasplacedtosupporttransmucosalhealing(Fig.8). After an impression was taken, the Implant Replica EVwasconnectedtotheImplantPick-UpEV(Fig.9). A plaster model was created and scanned. These data were transferred into the ATLANTIS VAD software. Figure 10 shows the virtual design of an ATLANTIS abutment in gold-shaded titanium. This abutment was placed in the model with gingiva mask, and final individual full ceramic lithium disilicate crowns (IPS e.max) were created (Figs. 11 & 12). TheATLANTISabutmentingold-shadedtitanium was installed using an abutment screw tightened to 25 Ncm (Fig. 13). Figures 14 & 15 show the facial and occlusal view of the final restorations at de- livery, with full ceramic crowns at teeth 12, 11, 21, and 22. A radiographic image taken when the final crowns were inserted demonstrates an excellent restorative fit with stable marginal bone levels (Fig.16).Sixmonthsafterthecrownswereinserted, a follow-up examination of the patient revealed excellent peri-implant tissue health (Fig. 17)._ Fig. 8_Implant placement region 21 and a HealDesign EV 4.8. Fig. 9_Implant Pick-Up EV 4.8 and Implant Replica EV 4.8 in impression material. Fig. 10_Virtual design of an ATLANTIS Abutment. Fig. 11_ATLANTIS Abutment positioned in the plaster model with gingiva mask. Fig. 12_Final individual full ceramic lithium disilicate crowns. Fig. 13_ATLANTIS Abutment in gold-shaded titanium in situ. Fig. 14_Facial view of the final restorations. Fig. 15_Occlusal view of the final restorations. Fig. 16_Radiographic image at insertion of final crowns. Fig. 17_Excellent peri-implant tissue health six months after insertion of the final restorations. Fig. 17 Fig. 14 Fig.10 Dr Michael R.Norton, BDS FDS RCS(Ed) Adjunct Clinical Professor, UPenn,Philadelphia,PA,USA Specialist in Oral Surgery Implant & Reconstructive Dentistry London,UK cone beam_contact Fig. 8 Fig. 9 Fig. 15 Fig. 16 Fig. 11 Fig. 12 Fig. 13 CBE0414_14-15_Norton 28.11.14 11:34 Seite 2 CBE0414_14-15_Norton 28.11.1411:34 Seite 2