cone beam – international magazine of cone beam dentistry

I case study _ implant treatment of the alveolar ridge can be followed and surgical adjustments to the ridge can be avoided (Fig. 2). Circumferentialretentionofthemarginalbone The OsseoSpeed Profile design provides bone support circumferentially, thus preserving the marginal bone and promoting the development of healthy peri-implant soft tissue. Because of its ability to preserve the bone lingually, buccally and approximally, the implant type is suitable in com- promised molar regions with typically lingually sloped bone. The importance of maintaining the marginal bone level was demonstrated by Tarnow2 who showed that the pres- ence or absence of a papilla largely depends on the distance from the bone leveltotheproximalcontactpointofthe crown. An increase of the distance from the contact point to the bone level from 5 mm to 6 mm reduces the probability of a papilla presence from nearly 100 % to 56 %. Bone resorption of only 1 mm can thus suppress the development of the papilla. The presented case shows that the vertical and horizontal atrophy of the jaw and the disappearance of the papil- lae could be countered successfully by using the OsseoSpeed TX Profile. Clinicalandradiographicexamination CBCT was used for the planning of the case. The CBCT image showed that region 46 had a bone level difference of about 2 mm and sufficient bone height above the inferior alveolar nerve. The ridge width and height were sufficient to place an implant with a 4.5 mm di- ameter and a 13 mm length. The inter- proximal papillae distal to tooth 45 and mesial to tooth 47 were reduced in height. Tooth 47 was clinically healthy. The en- dodontically treated tooth 45 had enamel defects, and improvement of its aesthetics with composite was planned for (Figs. 3 & 4). Surgicalworkflow After a crestal and intrasulcular incision, a mu- coperiosteal flap was elevated, revealing the sloped ridge. After marking the implant position about 2 mm buccally to the highest lingual jaw ridge, the initial preparation of the implant site was done using a surgical template, in accordance with the manufacturer’s protocol. During the pilot drilling, the implant axial alignment was monitored with paralleling tools. The correct drilling depth was measured with an implant depth gauge at the bone walls.InitialinsertionoftheOsseoSpeedProfilewas performed using the contra angle. However, the final alignment of the sloped im- plant shoulder must be performed manually using a specially marked implant driver. It enables the sloped implant shoulder to be aligned with the bonewithinafractionofamillimetre.Themarginal bone around the implant can thus be optimally Figs. 8a–b_Re-entry after 16 weeks. The buccal dehiscence defect regenerated without augmentation. Figs. 9a–b_Healthy and stable peri-implant conditions provide an optimal foundation for the prosthetic crown. Fig. 10_Individualised titanium abutment TiDesign Profile. Fig. 11_The ceramic veneered crown in region 46 immediately after cementation (about 5 months after implant placement). 10 I cone beam 1_2016 Fig. 11 Fig. 10 Fig. 9b Fig. 9a Fig. 8a Fig. 8b Fig. 13 Fig. 12 CBE0116_08-11_Noelken 21.01.16 11:00 Seite 3 CBE0116_08-11_Noelken 21.01.1611:00 Seite 3

cone beam – international magazine of cone beam dentistry

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