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ePaper created 2016-06-01, 09:58:05 | version 1.38.0
I 11 implants 1_2016 clinical article_ treatment planning I VetOne).Oraltrachealintubationwascompletedand anesthesia was maintained at vaporizer setting #3, O2 1L/minute following Feline Anesthetic Protocol (FAP). A complete oral exam and digital PA radiographs were obtained. A luxation of tooth #104 and some mobility was noted. Additionally, a widening of the periodontalligamentspacewithaverticalfractureof theincisiveboneatthediastemaofteeth#s103/104 was observed (Fig. 1). A sulcular full thickness MP flap was elevated to evaluate the alveolar process of the maxillary bone. The canine tooth (#104) was atraumatically extractedtoavoidanyfurtherdamagetothealveolar socket and surrounding bone. Socket debridement was performed and copious levage was complete with 0.9 percent NaCl (VetOne). The site was pre- pared to accept a 5.0 x10 mm Engage implant (OCO Biomedical, Albuquerque, N.M.), which was subse- quently placed into the osteotomy and positioned subcrestally with a final insertion torque of 45 Ncm. The crestal gap between the implant and socket was filled with Fusion Bone Putty (Veterinary Trans- plant Services (VTS), Kent, Wa.) to assist in socket regeneration and to minimize bone resorption.3, 4, 5 Acoverscrewwasplacedandtheflaprepositionedto achieve primary closure with 5-0 resorbable mono- filament sutures (Securos Surgical, Fiskdale, Mass.) (Fig. 2). Recovery was uneventful and the patient was discharged with post-surgical instructions the same day. Clavimox (62.5 mg/ml @ 1ml bid) (Zoetis, Florham Park, N.J.), a broad-spectrum antibiotic, and Buprenorphine(0.1mlbidorallyfor3-5days)(Reckitt Benckiser Healthcare, Parsippany, N.J.), an opioid pain reliever, were dispensed to the owner. _Uncovering and restoration phase At six months post-insertion, the patient was re- evaluated for soft-tissue healing and osseointegra- tion. FAP was again utilized as in the surgical phase. Dental radiographs were evaluated and implant stability and integration were determined to be adequate. A tissue punch was used to expose the implant head, preserving adequate attached gingiva on the buccal.Thecoverscrewwasremovedandclosedtray implant impression abutment was placed (OCO Bio- medical)andaradiographtakentoverifypropermat- ing of the impression head to the implant (Figs. 3a, 3b). Impressions were fabricated with a fast set VPS hand mix putty and a fast set light body VPS impres- sion material (Benco Dental Supply, Tucson, Ariz.). Atransmucosalhealingabutment(OCOBiomedi- cal) was placed to insure proper emergence profile to support the future prosthetic components6, 7 (Fig. 3c). The impression was sent to the dental lab (Doks Dental, Tucson, Ariz.), and a soft-tissue stone model was fabricated with analogs embedded within. The planned prosthetic was waxed up for a palladiumimplantrestoration,whichwouldbeluted into the implant (Fig. 4). Fig. 8_Clinical examination with endodontic file in the right maxillary canine (left) and radiograph demonstrating apical pathology at the mobile tooth (right). Fig. 9_Diamond being used on the residual root (a) to atraumatically extract the root, implant being inserted into the osteotomy (b), implant placed subcrestally (c) and site closed by primary intention (d). Fig. 10_Patient at initiation of restorative phase showing lack of inflammation at previously placed implant (a), tissue punch being used to expose the implant (b) and uncovery of the cover screw (c). Fig. 11_Radiograph of the implant at initiation of the restorative phase (top and bottom right) and after placement of healing abutment (bottom left). Fig. 8 Fig. 9 Fig. 10 Fig. 11