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ePaper created 2016-11-29, 09:17:25 | version 1.38.0
exhibitors 26 Greater New York Dental Meeting — Nov. 29, 2016 By Paresh B. Patel, DDS n Implant therapy is an accessible mode of treatment that can be exe- cuted with a high degree of predict- abilitybyfollowingsomesimplesteps and techniques. A common source of straightfor- ward, single-unit implant cases are patients who present with a tooth that has fractured or otherwise failed afterreceivingendodontictreatment. The treatment protocol to place and restore an implant in these situa- tionsisquiteapproachableandcanbe broken down into seven simple steps. Step 1 The tooth should be removed atrau- matically, 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. Step 2 To simplify the eventual placement of the implant, it’s important to pre- serve the bone by grafting the socket. Any granulation material should be carefully removed from the socket. The site should be irrigated and the walls scraped to initiate some bleed- ing. The socket is then filled up to the crest of bone with grafting material and sutured. Step 3 The extraction socket is allowed to heal for approximately four months. During this time, the grafting mate- rial helps maintain the bone volume that is essential to a simple, predict- able implant placement procedure and an esthetic, functional outcome. Step 4 After the socket site has healed, the patient returns for placement of the implant. The site can be evalu- atedintraorally,radiographicallyand with a periodontal probe to verify sufficient bone volume for implanta- tion and determine the diameter 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 the implant should be situated 1.5 mm from the adjacent teeth, with 1.5– 2.0 mm of bone on the facial aspect. The osteotomy is created follow- ing the manufacturer-recommended sequence of surgical drills for the diameter and length of implant being placed, with proper angulation and positioning confirmed radiographi- cally during the procedure. It is advantageous to place an implant with a pronounced thread design, such as the Hahn™ Tapered Implant System, which helps the cli- nician maintain directional control during insertion and establish high primary stability. A tapered 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 driver and then with a torque wrench so the stability of the implant can be determined. Step 5 After verifying adequate primary stability, a healing abutment, rather than a cover screw, can be delivered at the time of implant placement. Delivering a healing 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 uncover the cover screw. Step 6 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 dental lab fabricates the definitive restoration based on the final impression. Step 7 BruxZir® screw-retained crowns are esthetic,predictable,extremelydura- ble, easily retrievable and avoid the task of cementing the restoration overanabutment.Afterremovingthe healingabutment,thescrew-retained crown is seated, the prosthetic 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 general dentist has every reason to provide implant treatment to them directly. This expands the services and quality of care offered by the practice and gives the patient a better long-term solution to the problem of a missing tooth. Seven simple steps to implant success Here in New York To learn more about the Hahn Tapered Implant, stop by the Glidewell Labora- tories booth, No. 4334. 5 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. (Photos/Provided by Glidewell Laboratories) 3 The Hahn Tapered Implant Bundle, offered by Glidewell Laboratories.