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Dental Tribune Middle East & Africa Edition No. 5, 2015

Dental Tribune Middle East & Africa Edition | September-October 2015 33referral clinic < Page 32 > Page 34 Fig. 10a: Insertion of the MAX 7-11 Implant with the hand piece Fig. 11a: Selection of the appropriate size pre- machined Zirconia abutment cylinder Fig. 12a: The MAX 7 implant with a 7 mm diameter platform switches to 5.5 mm platform Fig. 12b: CER-ZR-58 with 5mm platform diameter diverges to a 8mm occlusal diameter to provide the appropriate porcelain support Fig. 9a: The MAX Implant 7-11 Southern Im- plants (7 mm diameter and 11 mm in length) Fig. 9b: The MAX Southern Implant range of di- ameter. Each of the sizes below is available in lengths 7,9,11mm and 13 Fig. 10c: The Max Implant platform is placed 1-2 mm below the crestal bone level and 1-2 mm away from the buccal plate Fig. 10b: Minimum insertion torque of 45 Ncm Fig. 11b: Correct Implant placement allows for a screw retention of the Zirconia tooth This implant is designed for im- mediate replacement of molar teeth as it is engineered to pro- vide high insertion torques to ensure maximum primary sta- bility at the time of the implant placement. Pre planning of the future position of the implant and the available bone is as- sessed in the 3-D implant plan- ning software prior to implant placement (Figure3a, b). In or- der to maximize the osteotomy preparation and ensure a screw- retained restoration, we have mastered the “drill through the tooth technique”. This is initi- ated once the crown is sectioned horizontally and detached at the cervical level (coronectomy) to increase the visibility while drilling through the tooth. (Fig- ure 4a, b). Consecutive drills are used to widen the hole within the tooth at a depth slightly short of the apex. By drilling through the tooth, the drills are stabilized and this prevents a traumatic osteotomy preparation (Figure 5a,b). Next the mesial and dis- tal roots are separated to ensure an atraumatic extraction and intact buccal and lingual wall. The separated roots are simply elevated into the space created and removed without causing any damage to the extraction site (Figure 6a, b, c). The peri- apical granuloma visible on the CBCT is now curetted, the ex- traction site is degranulated and irrigated with saline (Figure 7a, b). Bony Alveolar housing of the extracted site shows intact buccal, lingual, mesial and dis- tal walls (Figure 8). A Max 7-11 Southern implant in the dimen- sions of 7mm in diameter and 11mm in height is the appropri- ate size for this extraction sock- et. Should a larger diameter size implant be needed, then a larg- er range of sizes starting from 7mm to 10 mm in diameter de- signed for immediate placement within molar extraction sites can be selected (Figure 9a, b). The MAX implant is inserted at a minimum of 45 Ncm of torque or higher and the platform is placed 1-2mm deeper & 1-2 mm away from the buccal crest. (Fig- ure 10a, b). In order to fabricate the final restoration within the same day a pre-machined zirco- nia abutment is selected in order to fabricate a screw-retained restoration (Figure 11a, b). For this particular MAX 7-11 implant a zirconia abutment CER-ZR-58 is selected. The 5 represents the 5mm platform diameter and the 8 represent the divergence of the cylinder to an 8mm dimensions. Since the MAX 7mm diameter converges / platform switches to a 5mm platform, then a 58 zirconia is the appropriate abut- ment for this case (Figure 12a, b). Once the implant is placed and an abutment selected, the next step is to take an impres- sion to fabricate the final resto- ration. A fast setting, medium body, addition cured polyvinyl- siloxane is used and an open tray impression is made (Figure 13a, b, c, d). A healing abutment is placed and in four hours our in-house dental lab converts the zirconia 58 cylinder to an all-ceramic screw retained res- toration (Figure 14). The zirco- nia 58 cylinder is cut down and porcelain build up is completed prior to final glazing (Figure 15a,

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