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Dental Tribune Middle East & African Edition

Dental Tribune Middle East & Africa Edition | March-April 2015 7mCME < Page 6 mCME SELF INSTRUCTION PROGRAM CAPP together with Dental Tribune provides the opportunity with its mCME- Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership: Yearly membership subscription for mCME: 900 AED One Time article newspaper subscription: 250 AED per issue. After the payment, you will receive your membership number and Allowing you to start the program. Completion of mCME • mCME participants are required to read the continuing medical education (CME) articles published in each issue. • Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on http://www. cappmea.com/mCME/questionnaires.html. • Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. • A minimum passing score of 80% must be achieved in order to claim credit. • No more than two answered questions can be submitted at the same time • Validity of the article – 3 months • Validity of the subscription – 1 year • Collection of Credit hours: You will receive the summary report with Certificate, maximum one month after the expiry date of your membership. For single subscription certificates and summary reports will be sent one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE. teeth. The provisional was then reinserted. A Procera zirconia custom im- plant abutment was chosen. Zirconium implant abutments havenotonlybeennotedfortheir tooth-like color and esthetic ap- pealbutalsofortissuetolerability, highloadstrengthandintrasulcu- lardesignenhancement.11 The extraordinary load strength of the oxide ceramics is not com- promised by high bending and tensile strength, and fracture and chemicalresistance.11 Zirconium abutments are me- chanically equivalent to their metal counterparts but boast greaterbiologicalcompatibility.11 Results of a recent study pro- vide evidence that the ceramic oxide abutments can be safely utilized in the incisor region of both the maxilla and mandible as determined by maximal bite forces in the esthetic zone.11 Due to excellent restorative prop- erties in terms of strength and color conformity, the zirconium implant-abutment is becoming increasinglyfavoredbyclinicians for esthetically pleasing anterior implant restorations.12 A Procera zirconiacrownwasfabricatedfor this patient with Noritake CZR porcelain(Fig.3). At the time of insert, the provi- sionalcrownandimmediatetem- porary abutment were removed. The Procera zirconia custom abutment was seated, the screw washandtightenedandthescrew was torqued to 35 Ncm with the manual torque wrench. The ac- cesswasfilledwithasmallcotton pelletandtoppedwithathinlayer offlowablecomposite. The Procera zirconia crown was then seated; margins, con- tacts and occlusion were con- firmed; and the crown was cemented in place with 3M ESPE RelyX luting cement (Fig. 4). Casestudy2: fracturedmaxil- laryrightcentralincisor This patient, a healthy male in his late 30s, was examined in my office for a fractured maxillary right central incisor. The patient had Feldspathic porcelain resto- rations on his upper central and upper lateral incisors that were placed several years ago. He had ahistoryoftraumatotheanterior teethfromasportsinjuryandsub- sequentendodontictreatment. Recent periapical radiographs showedinternalresorptioninthe upper incisors (Fig. 5). The pa- tient sustained additional trauma tothemaxillaryrightcentralinci- sor through a fall, which resulted incompletefractureofthecrown (Fig.6).Thetoothwasnonrestor- able. After reviewing the different treatmentoptions,thepatientde- cided on an immediate implant restoration. Although the maxil- laryleftcentralincisoralsoexhib- ited signs of internal resorption, it was decided that treatment of that tooth would be performed at a later date. Consideration was given to the poor gingival archi- tecture that results from placing adjacent implants in the esthetic zone. Hewasthenevaluatedbytheperi- odontist for the surgical place- ment of the immediate implant for the maxillary right central in- cisor.Thepatient’streatmentwas similartothatofthepatientinthe firstcasestudy. The right central incisor was re- moved and a NobelReplace Ta- pered Groovy (internal connec- tion) 5.0 mm x 13 mm implant was placed. An osseous graft of demineralized freeze-dried bone wasutilizedtoaugmentthesurgi- cal site. The fixture received an emergence profile, healing abut- ment. The patient then received an immediate non-functioning provisional. Finalrestoration After the six-month heal- ing period the final restoration was fabricated. In this case, a one-piece screw-through abutment made from a Nobel Biocare GoldAdapt Engag- ing NobelReplace (Fig. 7) was fabricated in order to obtain a correct emergence profile of the restoration due to the slightly lingual placement of the implant (Fig.8). The restoration was seated, and the screw was hand tightened and then torqued to 35 Ncm with the manual torque wrench. The lingual screw access was filled withacottonpelletandcomposite restoration(Fig.9). Conclusion In the cases cited above, both patients had sustained injuries to their anterior teeth as young adults while engaging in sports. Each of the patients had been treated endodontically and expe- rienced internal resorption of the traumatized teeth approximately 15 years later. Both of their ca- reersandlifestylesdemandedim- mediate replacements that were non-removable and esthetically pleasing. The failing teeth were extracted and implants were inserted im- mediately and restored the same day with a non-functional loaded provisional. Immediate place- ment and restoration of a single implant offers a highly esthetic and timely treatment option in the case of internal resorption and tooth failure in the maxillary centralincisors. Furthermore, this treatment eliminates the need for a remov- able partial denture while main- taining the gingival architecture andpreventingalveolarboneloss intheextractionsite. As esthetic expectations of pa- tients and the desire for a con- venient and timely treatment continue to increase, instanta- neous replacement of failing teethisbecomingmoreroutine.13 Not only does placing the im- plant immediately following extraction maintain the alveo- lar architecture and retain the interdental papillas, placing the provisional immediately thereaf- ter refines the level of treatment the clinician can offer the pa- tient.Estheticqualityisenhanced without comprising long-term implant stability. Immediately placing and loading implants is both functionally and cosmeti- callybeneficial._ References 1) Mijiritsky E. Implants in con- junction with removable partial dentures:aliteraturereview.Im- plant Dentistry 2007; 16(2):146- 154. 2) Singh A, Gupta A, Yadav A, Chaturvedi TP, Bhatnagar A, SinghBP.Immediateplacementof implantinfreshextractionsocket withearlyloading.Contemporary Clinical Dentistry 2012; 3(Suppl 2):S219-222. 3) den Hartog L, Raghoebar GM, Stellingsma K, Vissink A, Mei- jer HJ. Immediate non-occlusal loading of single implants in the estheticzone:arandomizedclini- cal trial. Journal of Clinical Peri- odontology2011;38(2):186-194. 4) Saghezchi K. Replacing a sin- gle anterior tooth immediately after extraction with a single im- plant to preserve interproximal papilla and alveolar bone. The Journal of Cosmetic Dentistry 2004;19(4):70-76. 5) De Kok I, Chang S, Moriarty J, Cooper L. A retrospective analysisofperi-implanttissuere- sponses at immediate load/pro- visionalized microthreaded im- plants. International Journal of Oral and Maxillofacial Implants 2006;21(3):405-412. 6) Ormianer Z, Schiroli G. Max- illary single-tooth replacement utilizing a novel ceramic re- storative system: Results to 30 months. Journal of Oral Implan- tology2006;32(4):190-199. 7) BeckerCM,WilsonTGJr,Jen- sen OT. Minimum criteria for immediate provisionalization of single-tooth dental implants in extraction sites: a 1-year retro- spective study of 100 consecutive cases. Journal of Oral and Maxil- lofacial Surgery 2011; 69(2):491- 497. 8) MalchiodiL,CucchiA,Ghensi P,NociniPF.Evaluationofthees- thetic results of 64 nonfunctional immediately loaded postextrac- tion implants in the maxilla: cor- relation between interproximal alveolar crest and soft tissues at three years of follow-up. Clini- calImplantDentistryandRelated Research 2011 Dec 16; Epub aheadofprint. 9) Ne R, Witherspoon D, Gut- mann J. Tooth Resorption. Quin- tessence International Dental Digest1999;30(1):9-25. 10) Gunraj MN. Dental root re- sorption. Oral Surgery, Oral Medicine, Oral Pathology 1999; 88(6):647-653. 11)GehrkeP,DhomG,BrunnerJ, Ing D, Wolf D, Degidi M, Piattelli A.Zirconiumimplantabutments: Fracture strength and influence of cyclic loading on retaining- screw loosening. Quintessence International2006;37(1):19-26. 12) Biow Tan P, Dunne J. An es- thetic comparison of a metal ce- ramiccrownandcastmetalabut- ment with an all-ceramic crown and zirconia abutment: a clinical report.JournalofProstheticDen- tistry2004;91(3):215-218. 13) Barone A, Rispoli L, Vozza I, Quaranta A, Lovani U. Immedi- ate restoration of single implants placed immediately after tooth extraction. Journal of Periodon- tology2006;77(11):1914-1920. Fig.5 Fig.6 Fig.7 Fig.9 Fig.8 Susan McMahon, DMD, is in pri- vate practice in Pittsburgh. She is accredited by the American Acad- emy of Cosmetic Dentistry and is a six-time award winner in the AACD Annual Smile Gallery. She has served as a clinical professor in prosthodontics and operative dentistry at the University of Pitts- burgh, School of Dental Medicine. McMahon is a guest lecturer in cosmeticdentistryatWestVirginia School of Dentistry and lectures to dentists in the United States and Europe. You may contact McMa- honat www.wowinsmile.com. Karrah Petruska is a graduate of the University of Wisconsin-Mad- ison. She is in the dual master’s program, post-baccalaureate pre- medical program and master’s of health management systems at DuquesneUniversity. About the Authors +97143616174

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