Dental Tribune U.S. Edition No.5, 2016

Dental Tribune U.S. Edition | May 2016 A12 INDUSTRY NEWS By Paresh B. Patel, DDS Implant therapy is an accessible mode of treatment that can be ex- ecuted with a high degree of predict- ability by following some simple steps and techniques. A common source of straightforward, single-unit implant cases are patients who present with a tooth that has fractured or otherwise failed after receiving endodontic treat- ment. The treatment protocol to place and restore an implant in these situa- tions is quite approachable and can be broken down into seven simple steps. Step1: The tooth should be re- moved atraumatically, taking care to preserve as much of the buccal plate and surrounding bone as possible. After using a very fine diamond bur to trace around the root, periotomes can be situated between the root and the bone to aid atraumatic removal. Step2:To simplify the eventu- al placement of the im- plant, it’s important to preserve the bone by grafting the socket. Any granulation material should be carefully removed from the socket. The site should be ir- rigated and the walls scraped to initiate some bleeding. The socket is then filled up to the crest of bone with grafting ma- terial and sutured. Step3: The extraction socket is allowed to heal for ap- proximately four months. During this time, the grafting material helps main- tain the bone volume that is essential to a simple, predictable implant placement procedure and an esthetic, functional outcome. Step4: After the socket site has healed, the patient returns for placement of the implant. The site can be evaluated intraorally, ra- diographically and with a periodontal probe to verify sufficient bone volume for implantation and determine the di- ameter of the implant. The flapless implant placement is an excellent, minimally invasive option for many of these cases. To begin the flapless surgical procedure, a tissue punch is used to create an opening for the osteotomy, noting that the implant should be situated 1.5 mm from the ad- jacent teeth, with 1.5–2.0 mm of bone on the facial aspect. The osteotomy is created following the manufacturer-recommended se- quence of surgical drills for the diame- ter and length of implant being placed, with proper angulation and position- ing confirmed radiographically during the procedure. It is advantageous to place an implant with a pronounced thread design like the Hahn™ Tapered Implant System, which helps the clinician maintain di- rectional control during insertion and establish high primary stability. A ta- pered implant design is also beneficial, as the tooth-root-like shape is easier to situate within the available bone. The implant is first threaded into the osteotomy site using a handpiece driv- er and then a torque wrench so stabil- ity of the implant can be determined. Seven simple steps to implant success Step7: BruxZir®screw-retained crowns are esthetic, predictable, extremely durable, easily re- trievable and avoid the task of cementing the restoration over an abutment. After removing the healing abutment, the screw-retained crown is seated, the pros- thetic screw is tightened, and the access hole is filled with Teflon tape and sealed using composite. Conclusion With so many patients requiring single-unit extractions presenting for treatment, the properly trained gener- al dentist has every reason to provide implant treatment to such patients di- rectly. This expands the services and qual- ity of care offered by the practice and gives the patient a better long-term solution to the problem of a missing tooth. Approaching a straightforward, single-unit implant case involving a tooth that has fractured or otherwise failed Step5: After verifying ad- equate primary stabil- ity, a healing abutment, rather than a cover screw, can be delivered at the time of implant placement. Delivering a heal- ing abutment is advantageous as it helps contour the soft tissue to form a healthy, esthetic transmucosal emergence as the implant integrates and avoids the need for a second surgical procedure to un- cover the cover screw. Step6: Approximately three months after implant placement, the patient returns for the final impression. After removing the healing abutment, an impression coping is connected to the implant and a closed- tray impression is taken using a vinyl polysiloxane material, such as Capture® (Glidewell Direct; Irvine, Calif.). The den- tal lab fabricates the definitive restora- tion based on the final impression. After extracting the untreatable tooth, augmenting the bone and allowing the site to heal, a Hahn Tapered Implant was placed in ideal position for the final screw-retained BruxZir crown. Photo/Provided by Dr. P aresh B. Patel Dr. Paresh Patel is a graduate of the University of North Carolina at Chapel Hill School of Dentistry and the Medical College of Georgia/AAID MaxiCourse. He is cofounder of the American Academy of Small Diameter Implants and a clinical instructor at the Reconstructive Dentistry Institute. Patel has placed more than 2,500 small-diameter implants and has worked as a lecturer and clinical consultant on mini implants for various companies. He belongs to numerous dental organizations, including the ADA, North Carolina Dental Society and AACD. He also is a member and president of the Iredell County Dental Society in Mooresville, N.C. Patel can be contacted at pareshpateldds2@ gmail.com or www.dentalminiimplant.com. ‘The properly trained general dentist has every reason to provide implant treatment to such patients directly’ CDA BOOTH NO. 1470 (Reprinted by permisision of Glidewell Laboratories, ©2016 Inclusive magazine)

Dental Tribune U.S. Edition No.5, 2016

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