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ePaper created 2015-10-28, 09:28:35 | version 1.38.0
industry Implant Tribune U.S. Edition | November 2015C10 Immediate, esthetic tooth replacement with the Hahn Tapered Implant and BruxZir Anterior Solid Zirconia By Timothy F. Kosinski, DDS, MAGD W ith more patients seeking dental implant treatment, it’s no surprise that grow- ing numbers of clinicians are providing this service. The increased demand for implant therapy can be at- tributed in part to the improved predict- ability brought about by innovations in implant design. Additionally, due to advancements in all-ceramic restorative materials, pro- viding esthetic results is easier than ever before. By utilizing the most ad- vanced implants and restorative mate- rials, even experienced implantologists have the potential to benefit from an improved clinical workflow and more esthetic results. The case report that follows demon- strates immediate tooth extraction and placement of a Hahn Tapered Implant (Glidewell Direct; Irvine, Calif.) in the area of a lateral incisor. A temporary bridge, custom implant abutment and a highly esthetic final crown are utilized to facilitate a natural-looking final res- toration. Case report A 40-year-old male presented with no medical complications and desired a nice smile for his business interactions. His maxillary left lateral incisor had fractured, with the patient’s excessive parafunction likely a contributing fac- tor. Endodontic evaluation had deter- mined that the lateral incisor was un- treatable. The patient accepted a treatment plan in which the lateral incisor would be extracted and an implant immediately placed. Designed to achieve the maxi- mum primary stability needed for im- mediate extraction and implantation cases, a Hahn Tapered Implant was se- lected for the procedure. To begin treatment, the non- restorable lateral incisor was extracted atraumatically. Removing the tooth in this manner maintained the facial plate of bone as well as the interseptal bone that helps support the interdental pa- pillae. A pilot drill was utilized to create the initial osteotomy approximately 3 mm apical to the adjacent cemento- enamel junction, and a 3.5-mm- Fig. 1: Postoperative periapical radiograph illustrates excellent integration of the Hahn Tapered Implant (right) with the surrounding bone in the area of tooth #10. Photos/Provided by Dr. Timothy F. Kosinski diameter Replace Select™ drill (Nobel Biocare; Yorba Linda, Calif.) was used to complete preparation of the implant site. Note that the Hahn Tapered Im- plant is compatible with widely used surgical instrumentation. As the implant was threaded into place, its prominent buttress threads engaged the palatal wall firmly. This simplified the effort of preserving the facial plate and positioning the im- plant in a manner that would foster an esthetic outcome. The tapered body of the implant eased placement within a maximum amount of bone, and its widened apex helped establish excel- lent stability. Radiography confirmed the implant was placed in an optimal position. A transitional bridge was fabricated to minimize speech problems, help sup- port the soft tissue and maintain a natural emergence profile during the healing period. After four months of healing, the temporary bridge was re- moved, and an open-tray final impres- sion was taken. An Inclusive Zirconia Custom Abut- ment with titanium base was pro- duced by the lab and maintained a nat- ural emergence profile upon delivery. BruxZir Anterior, a monolithic zirco- nia material specially formulated for the smile zone, was chosen for the fi- nal restoration because of its strength and lifelike esthetics. The crown, which was digitally de- signed and milled using CAD/CAM technology, exhibited a precise fit. Final radiography illustrated superb bone preservation at the implant site (Fig. 1). Optimal soft-tissue contours were particularly evident around the beveled edge of the Hahn Tapered Im- plant. The patient expressed that he was very pleased with the final resto- ration (Fig. 2). Conclusion The high primary stability, optimal positioning and simplified surgical protocol facilitated by the Hahn Ta- pered Implant make it ideal for a wide range of indications, including imme- diate extraction cases and restorations in the smile zone. When combined with BruxZir Ante- rior and zirconia hybrid custom abut- ments, a predictable restoration can be delivered that mimics the esthetics of the tooth being replaced. Note: See more of this case by visit- ing www.inclusivemagazine.com. Fig. 2: The final restoration of tooth #10 exhibited translucency, color and emergence profile similar to natural dentition. ‘Removing the tooth in this manner maintained the facial plate of bone as well as the interseptal bone that helps support the interdental papillae.’