Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-06-01, 09:58:05 | version 1.38.0
12 I I clinical article_ treatment planning At one-month post impressions, the patient returned for delivery of the implant restoration. FAP was again utilized and the prostheses was tried in and then was cemented into the integrated implant utilizing a self-adhesive resin cement (BisCem, Bisco Inc., Schaumburg, Ill.) (Fig. 5). The 26-month follow-up demonstrated excellent emergence profile and implant stability with no evi- dence of periimplantitis or soft-tissue inflammation surrounding the implant restoration (Figs. 6, 7). _Case report 2 A 14.3-year-old male neutered DLH cat weigh- ing 16.2 pounds presented for an oral examination. Generalizedcalculusandgingivitiswasnoted,aswell as multiple Feline Oral Resorptive Lesions (FORL) and a complicated crown fracture of the right maxillary canine (#104). Initial treatment options were discussed with the owner, which included scaling and root planing to treat the generalized periodontal condition and selective extractions determined by the initial prob- ing and dental radiographs. The fractured canine treatment would be discussed after a complete oral examinationandradiographswerecompletedunder a general anesthesia. The right maxillary canine (#104) fracture appeared to have been present for a long period with some definite buccal bone changes related to the fracture. _Surgical phase Patient was pre-medicated with Atropine Sul- phate (1/120 grain; .2 ml subcutaneously) (VetOne) and Acepromazine (10 mg/ml; .05 ml subqutane- ously) (VetOne). General anesthesia was induced by mask with Sevoflurane (Vaporizer #7 / O2 at 4L/ minute)(VetOne).Oraltrachealintubationwascom- pleted and anesthesia was maintained at vaporizer setting #3 / O2 at 1L/minute following Feline Anes- thetic Protocol (FAP). A complete oral exam and dental radiographs were obtained. Multiple FORL were noted and charted. FORL are common in cats and are similar to cervical external resportive lesions in humans. These teethtypicallyhaveapoorprognosisandrequireex- traction to treat them. Selective surgical extractions were successfully completed while tension-free tissue flaps were placed at the extraction sites to achieve primary closure. The right maxillary canine (#104) had sustained a priortraumaticfracturewithpulpexposure.Definite buccalenlargementconsistentwithalveolarinflam- mation (osteitis) was present. Radiographs con- firmed the diagnosis with secondary root changes evident (Fig. 8). Endodontic treatment would have been an option; however, the root morphology and sclerotic canal would be problematic. As in Case 1, the owner elected to extract the tooth and place an immediate endosseous implant, ifpossible,andwaitfour-to-sixmonthsbeforeafinal restorationcouldbeplaced.Inmanycases,theauthor isplacingimmediateimplantswiththefutureoption of restoration utilizing digital treatment planning. Using these advanced computer-aided techniques (extra-oral scanning and CAD/CAM design and mill- ing),finalresultshaveproventobeexceptionalcom- pared to the traditional methods of VPS impression taking and wax-cast restorations. A coronectomy was made on the right maxillary canine (#104) for easy access of the tooth root. It is imperativetoremovetheremainingrootwhilemain- taining the buccal eminence. A mini envelope flap was utilized to maintain a good blood supply to the crestal bone. A fine diamond burr (#FG 703) (Benco Dental) in a high-speed water cooled drill was used to detach the periodontal ligament, making luxating and extraction a simpler process with less risk of alveolar fracture (Fig. 9a). Examination of the socket was performed and removalofanyinflammatorygranulationtissuewas accomplished with a curette and fissure burr. Socket measurements (probing and radiograph) were ob- tained and the site was prepared to accept a 5.0 x10 mm Engage implant (OCO Biomedical), which was implants 1_2016 Fig. 12 Fig. 13 Fig. 14 Fig. 12_Closed tray impression head placed onto implant to take impression (bottom left) and healing abutment in place (top right). Fig. 13_Virtual cast with analog created using digital scanning of the soft-tissue model ready for virtual design of the restoration. Fig. 14_Completed CAD/CAM metal abutment and zirconia crown (top) and the abutment on the soft-tissue model (bottom left) and with crown inserted over the abutment (bottom right).