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Implant Tribune Middle East & Africa Edition No. 4, 2017

Dental Tribune Middle East & Africa Edition | 4/2017 IMPLANT TRIBUNE C2 Long-Term Clinical Success with the Neoss Implant System: A Case Report By Dr. Thomas Zumstein, Switzerland In this article Dr. Thomas Zumstein presents a Neoss implant case that has been in function for more than 11 years. The case shows that long-term success and stable bone levels can be achieved in a predictable way with a high level of simplicity using the Ne- oss implant system. The clinical case is part of a previous- ly published long-term study popu- lation on Neoss implants. The five year data from the study (Zumstein 2012) showed an overall survival rate of 95.0% and an average marginal bone loss of 0.4 mm during the first 5 years in function. These results in- dicate predictable treatment with good clinical outcome and stable bone levels after 5 years in function. The study has now been followed up for 10 years with no additional fail- ures and no further bone loss since the 5-year follow-up. Case background A 41 year old woman came to our clinic with missing first molars on both sides of the mandible (Figure 1). The patient was healthy, with a good oral hygiene, she was a non- smoker and with good compliance. This made her a good candidate for implant treatment. The main challenge in this case was the large space in the right molar area (position 46). The question in such case is whether to place one or two Implants, and in which positions to place them. In such cases, if excellent implant stability can be obtained, I prefer to place one implant in the distal socket and the restoration with a crown with a mesial cantilever. I prefer this for several reasons: • Smaller space between implant and adjacent teeth • Less food impaction • Better possibility to maintain a good oral hygiene • Better esthetics: “more tooth than tulip“ • Better economic value for the pa- tient One risk with this approach is unfa- vorable load conditions due to the cantilever. Therefore it is crucial to ensure that the implant stability is high and that the occlusal loads of the cantilever are minimized. In ad- dition there are a few additional con- siderations I make when planning for a cantilever: • The natural tooth next to the can- tilever is very important. It provides sensory feedback and minimizes the risk of overloading the cantilever when biting. • The cantilever should always be on the mesial side, since the bite forces are higher on the distal side of the reconstruction. • The patient should not have any periodontal problems. If the patient is missing many teeth, the bite forces on each unit is increased and thereby the risk of overloading the cantilever is increased. Implant placement Two Neoss 4.0 x 11 mm implants were placed, one implant was placed in the left first molar area and anoth- er in the right first molar area. A dis- tal position was chosen in the right first molar area, correct position and direction was ensured during drill- ing using a direction gauge (Figure 2). The implant was placed in a slight supracrestal position (Figure 3). If you have good keratinized soft tis- sue and you can place the implant as shown, then bone augmentation (GBR) is not necessary. In this case a cover screw was placed (Figure 4) and the implant was submerged during the healing period. It is crucial to place the implant with a good primary stability and to ob- tain correct position and direction of the implant, in order to assure con- trolled loads and that the implant can be easily restored with a screw retained reconstruction. Healing protocol The implants were allowed to heal submerged for 12 weeks. After reo- pening, PEEK healing abutments were connected to the implants (Figure 5) and the soft tissue were allowed to heal for an additional 2 weeks before impression taking. Impression taking After soft tissue healing, impres- sion copings were connected to the implants (Figure 6 and 7), note the good position and direction of the implants. I recommend to always use an open impression tray. The reposition of the implant replica is much easier for the technician. The impression tray was modified with access holes that matched the implant positions (Figure 8). Extension tubes were mounted on the impression copings and an impression was taken (Figure 9). Prosthetic workflow The lab created cast, wax up frame- works in gold (Figure 10) on Neolink abutments. The final crown was a gold ceramic screw retained single crown (Figure 11). Note the tight con- tact between the crown and adjacent teeth, both mesially and distally. Prosthetic delivery At time of prosthetic delivery, the PEEK healing abutments were dis- connected and a healthy soft tissue ÿPage C3 Figure 1: Initial situation Figure 2: Direction gauge during drilling Figure 3: Slight supracrestal implant placement Figure 4: Cover screw connected Figure 5: PEEK healing abutments Figure 6: Impression copings Figure 7: Impression copings Figure 8: Individualized impression tray Figure 9: Impression taking Figure 10: Gold framework Figure 11: Gold ceramic screw retained single crown Figure 12: Healthy soft tissue after healing Figure 13: Definitive prosthesis Figure 14: Definitive prosthesis Figure 15: Screw access holes closed Figure 16: Clinical situation after 11 years

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