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implants - international magazine of oral implantology No. 4, 2015

I case report 24 I implants4_2015 ular expansion and placement of a self-tapping coni- cal implant (Axiom PX®, Anthogyr). In this case, in which bone recovery along the osteotomy walls was not necessary, only convex inserts were used. The palatal and subcrestal position of the implant was re- spected (Fig.14). The gap between the implant and the vestibular cortical bone is not filled. Careful choice of theimplantabutmentenablesanidealemergenceboth in terms of hard tissue and soft tissue. The temporary crownistherebyshapedinsuchawaythatitclosesthe gapbyslightlycompressingthemarginalgum(Fig.15). It was mounted out of functional occlusion. Of course, the patient was advised to avoid voluntary chewingonthisimplantaswellaslocalcleaningwith cotton soaked in Chlorhexidine. Following verifica- tion of the osseointegration (Fig. 16), the impression was made eight to ten weeks after surgery, followed by placement of the permanent prosthesis (Fig. 17). _Conclusion The implant placement technique with the use of osteotomes is not a new concept. On the other hand, usinganautomaticosteotomeprovidesabetterview of the site, makes it possible to practice flapless sur- gery, to position more precisely and obtain more ho- mogeneousprogression,incomparisontousingbone taps with a surgical mallet. From the patient's per- spective, surgical comfort is significant and very no- ticeable. Itshouldbeborneinmindthatifyouwanttoavoid using filling materials, tissue must be conditioned to enable its regeneration. For immediate post-extrac- tion implant placement, lasers are of unrivalled use- fulness,becausetheyenablesocketdecontamination and induce bone regeneration. If the basic principles of this bone regeneration are respected, the condi- tions are adequate enough to enable bone growth withouttheuseofbiomaterials.Theseadvantagesare decisiveduringpreparationssuchasalveolarsinuslift as well as "split crest" where the buccal cortical bone is generally very fragile. Vitalimportanceisattributedtotheclosureofsoft tissue during implant placement; either by carefully choosingthehealingscrew(theheightanddiameter) ortheimplantabutment,enablingslightcompression of soft tissue and providing the implant/prosthetic connectionsystemwitha'barrier'thatenablesthere- generation of the two families of tissues. These minimally invasive techniques still require many improvements and more wide-spread valida- tion.However,forethicalandsafetyreasons,theprac- titionershouldalwayssuggesttheleastinvasivetech- niquethatcontributesto,guidesandinducesthistis- sueregenerationforwhichmostofthetimeswehave the matrix around these traumatised zones._ Editorial note: A list of references is available from the publisher. Fig. 13_Use of OsteoSafe® in the extraction socket after debridement and decontamination. Fig. 14_Positioning of the implant. Fig. 15_Immediate implant placement with temporary crown. Fig. 16_Control panoramic view at two months. Fig. 17_Permanent crown at three months. contact Dr Gilles Chaumanet,MSc Exclusive Oral and Maxillofacial Surgery Private practice inVilleneuve-Loubet (France) and Verona (Italy) www.drchaumanet.com Fig. 17Fig. 16Fig. 13 Fig. 15Fig. 14

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