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Implant Tribune United Kingdom Edition

May 201416 Implant Tribune United Kingdom Edition Kreppel M, Neugebauer J, Mis- chkowski RA, Zinser MJ, Zöller JE.: CBCT device dependency on the transfer accuracy from computer-aided implantology procedures. Clin Oral Implants Res. 2012 Sep;23(9):1089-97. doi: 10.1111/j.1600-0501.2011.02272.x. Epub 2012 Jun 11. 25) Zafiropoulos GG, Deli G, Bar- tee BK, Hoffmann O. a case series using two different implant de- signs. J Periodontol 2010; 81:604- 615.Single-tooth implant place- ment and loading in fresh and regenerated extraction sockets. Five-year results: 26) Mura P. Immediate loading of tapered implants placed in pos- textraction sockets: Retrospective analysis of the 5-year clinical out- come. Clin Implant Dent Relat Res 2010. 27) Block MS, Mercante DE, Lirette D, Mohamed W, Ryser M, Castellon P.: Prospective evalu- ation of immediate and delayed provisional single tooth restora- tions. J Oral Maxillofac Surg 2009; 67:89-107. 28) Linares A, Mardas N, Dard M, Donos N.: Effect of immediate or delayed loading following imme- diate placement of implants with a modified surface. Clin Oral Im- plants Res 2011; 22:38-46. 29) Atieh MA, Payne AG, Duncan WJ, Cullinan MP.: Immediate res- toration/loading of immediately placed single implants: is it an effective bimodal approach? Clin Oral Implants Res 2009; 20:645- 659. 30) Crespi R, Capparé P, Gherlone E, Romanos GE : Immediate ver- sus delayed loading of dental im- plants placed in fresh extraction sockets in the maxillary esthetic zone: a clinical comparative study. Int J Oral Maxillofac Implants. 2008 Jul-Aug;23(4):753-8 31) Crespi R, Capparè P, Gherlone E, Romanos G.: Immediate provi- sionalization of dental implants placed in fresh extraction sock- ets using a flapless technique. Int J Periodontics Restorative Dent. 2012 Feb;32(1):29-37 32) Glauser R, Ruhstaller P, Win- disch S, Zembic A, Lundgren A, Gottlow J, et al.: Immediate oc- clusal loading of Branemark System TiUnite implants placed predominantly in soft bone: 4-year results of a prospective clinical study. Clin Implant Dent Relat Res 2005;7 Suppl 1:52-59. page 15DTß Fig. 41-43: The initial situation in the 4th quadrant shows concave parts and alveolar structures that were not completely ossified. Tooth 23 could not be preserved, so the model cast prosthesis was widened by Tooth 23 in the maxilla. After the patient had received a periodontal treatment and had been informed about possible therapy solutions, the patient opted for a fixed implant-supported restoration in the sites 46 and 47. We provided the pa- tient with a passive-fitting restoration. Tooth 45 was also provided with a crown. In this way, the patient was able to “feel” his implants. Fig. 44 - 46: The patient was treated under anesthesia (UDS forte). He was given 600 mg Ibuprofen. With the yellow, black, white and blue drills, we drilled in the D1/D2 bone at a maximum rotation speed of 250 rpm. Then, we checked the bone cavity quality with the BCC (Bone Cavity Check) probe. Then, we inserted the Champions (R)Evolution® implant with the Insert/Shuttle, which had been fixed on the implant at a torque of only 10 Ncm Ex Works, at torques ranging from 40 to 60 Ncm. In most cases, the Shuttles remain aleo loco. Then, we set Gingiva-Clix on the Champions®-Insert/Shuttle immediately after an X-ray check. The Gingiva-Clix, which are made from biocompatible WIN! serve as transgingival healing caps. They are available in a combination of six widths and heights. Fig. 47 - 49: After eight weeks, when – independent of bone type – the transition of all Champions® from Primary Osseointegration Stability to Secondary Osseointegration Stability can be assured, we remove the Gingiva-Clix and the small screw from the Insert/ Shuttle and screw the metal impression posts in the Insert/Shuttle. In this case, we prepared Tooth 45, which was then provided with a crown. The impression can be made without removing the Insert/Shuttle from the implant and without contaminating the implant with saliva. The impression of this two-piece implant system is made transgingivally or supragingivally. Implant expo- sure and anesthesia are usually not necessary. Fig. 50 - 52: After taking X-rays, we fixed the white impression copings on the metal impression posts and made a closed impression. Fig. 53 - 55: The abutments are chosen. Then, the final prosthodontic restoration is fabricated. When fitting the prosthodontic restoration, the Gingiva-Clix are removed, and the Inserts/Shuttles are removed from the implant for the first time. With a Pattern Resin key, you can set the abutments in the 9.5° Champions inner cone and screw them at a torque of 30 Ncm. Fig. 59: This figure shows 8 placed 3.5 mm-diameter and 10 mm-diameter Champions (R)Evolution® implants, which were inserted transgingivally using the flapless MIMI® method. The bone cavity depth corresponded to the implant length. After each drilling and step, the bone cavity was checked in all dimensions. After taking X-rays, the Insert/ Shuttle was removed, and the implants were immediately restored with Ball-Head Abutments to fix the prosthesis in the maxilla. Because of the gentle, patient-friendly and periosteum preserving keyhole and flapless MIMI® method, which is indicated in at least 80% of the cases, you hardly see any bleeding and open wounds. With this method, swelling, pain, and hematomas following an implantation are now a thing of the past in many cases. However, even if this technique might be quite easy to learn, it is not always suitable for beginners in Implantology. In order to apply the MIMI® method successfully, it is necessary that the dentist has enough experience in Implantology and that he/she has considerable manual dexterity. Fig. 60: This 99 year-old patient from Munich (patient at risk) was the oldest patient worldwide who was treated with implants using the flapless MIMI® method. In June 2011, this lady was provided with four implants to support a full prosthesis in the mandi- ble. Under local anesthesia, surgery lasted about 20 minutes, and the preparation of the restoration and matrices in the dental laboratory took about 2 hours. Two hours follow- ing surgery, she was able to eat an apple strudel. Two years later, she was still satisfied with her implants and did not experience any pain. Fig. 56 - 58: After closing the abutment screws with Cavit, the crowns can be fixed with ImplantLink semi (company Detax, Champions- Liga). Fig 41 Fig 42 Fig 43 Fig 44 Fig 45 Fig 46 Fig 47 Fig 48 Fig 49 Fig 50 Fig 51 Fig 52 Fig 53 Fig 54 Fig 55 Fig 56 Fig 57 Fig 58 Fig 59 Fig 60

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