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ePaper created 2016-11-23, 14:26:06 | version 1.38.0
industry | 25 4 2016 implants cause the manufacturer promised that considerable primarystabilitycouldbeachievedduetotheaggres- sive threading in the lower third section of the im- plant,andontheotherhandbecauseIhadtodealwith averyshortresidualrootofthe53.Thelatterallowsa small extraction alveole and thus sufficient bone for a good primary stability, and thus the possibility of inserting a temporary crown immediately after im- plantation. Procedure I removed element 53 atraumatically; the mesial and distal papillae remained intact. By using a very sharp osteotome (Netwig) as a guide, I determined the location (more to palatal) and the direction of the preparation (Fig. 3). I gently tapped this osteo- tome to approximately 8 mm (according to calibra- tion) into the jaw bone, and by rotating it slightly, I achieved a good guide preparation. After this, I used theDentakK-systemforfurtherpreparation(Fig.4). This set consists of a hollow drill shaft containing a grinder in which, during further preparation, the bone is collected and then used to fill the space around the preparation and the residual alveolar bone.Idrilledtonomorethantwo-thirdsofthede- siredpreparationlength.ThenarrowestK-drillhasa 3.2 mm diameter so that the preparation at the top isslightlywiderthanthe2.8 mmimplanttobeused. This gives the option to adjust the implant some- what in the axial direction if necessary. I used a 2.6 drill of the Anthogyr implant system (Fig. 5) to bring the preparation to the correct length. The total length of the preparation is 13 mm so that the implant can be placed 1 mm under the bone edge (Fig. 6). There is very good primary stability (> 35 Ncm) (Fig. 9). After fitting a temporary abutment made of PEEK (polyether ether ketone, Fig. 7), I made a temporary composite crown. The PEEK temporary abutment is easy to construct using composite or temporary resin.Thistemporaryabutmentalsohasa1.5°morse taper, which provides good friction retention and does not damage the cone in the implant. Before placing the temporary crown, I applied the bone ob- tained in the hollow drill shaft on the labial side and condensed it so that the alveolus is filled properly (Fig. 8). The temporary crown was shaped in such a way in the cervical area that the alveolus was com- pletely covered. Of course, I checked that no func- tional stress occurred (Fig. 10). At the follow-up check a week later, a good adaptation of the mucosa wasalreadyvisible.Thepatienthadnoproblemsatall. After ten weeks, I removed the temporary crown with abutment. This is easy using a crown removal pliers vertically. Using a pop-in impression coping, I made an impression in a closed tray. The lab then Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 3: The preparation was performed precisely using Netwig-osteotome. Fig. 4: The autologous bone was crushed and harvested using the Dentak K-system. Fig. 5: The preparation was inserted at the depth using a 2.6 drill. Fig. 6: Insertion of the implant 1 mm under the bone crest level. Fig. 7: The PEEK abutment in situ. Fig. 8: The harvested bone was attached around the implant with Dentak K. 42016