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ePaper created 2017-11-09, 09:28:26 | version 1.38.0
industry | Fig. 4 Fig. 7 Fig. 5 Fig. 6 Fig. 8 Fig. 4: The alveolus was cleaned and filled in with an alveolar cone made from collagen. Fig. 5: After four months of integration. Fig. 6: DVT image for planning purposes. Fig. 7: Minimally invasive flap formation. Fig. 8: Marking the position of the implant. tion, a method which was first outlined by Sailer and Pa- jarola in 1996 as a means to categorise the complexity involved in implant surgery, the risk profile was low in terms of surgical, aesthetic and restorative evaluations.11 The patient was made aware of a gentle tooth extraction procedure. She was extremely opposed to having a con- ventional bridge restoration and expressed that she would like a metal-free, fixed implant. She was made aware of the small amount of evidence-based documentation concern- ing ceramic implants, in comparison to the documentation available concerning titanium implants, and she was also informed about the advantages and disadvantages of two-part ceramic implants. The patient opted for the two- part implant as she did not want to wear the protective shield necessary to ensure that a one-part ceramic im- plant becomes integrated due to aesthetic reasons. Pre-implant procedures The first step was to extract tooth 24 with a minimally invasive and particularly gentle procedure (Fig. 3). It is imperative that the alveolar bone structure is preserved so that there is minimal resorption of hard- and soft-tissue postsurgery. By using periotomes, it means that desmo- dontal fibres rupture during this method of extraction and teeth, or more specifically the remains of the root, can be carefully removed whilst keeping the expansion of the alveolar bone to a minimum. Due to apical inflam- mation, and from an economical perspective, in order to save costs, the aim was to let the patient heal autolo- gously, without any bone replacement material. The al- veolus was cleaned and filled in with an alveolar cone made from collagen (PARASORB HD Cone, RESORBA Medical; Fig. 4). After approximately two weeks had passed, the extraction alveolus was closed with provi- sional connective tissue and the primary cancellous bone started to develop. Inserting the implant During the four-month recovery phase, the filling in tooth 25 was renewed, parodontal pretreatment was completed and the patient was taught about oral hygiene procedures. Before the implant was inserted, a DVT was produced in order to depict the anatomic structure of the surrounding area and to determine the exact position for the implant (Figs. 5 & 6). The bone bed is prepared for the implant (CERALOG Hexalobe, CAMLOG) to be in- serted as per the surgical protocol specified. After a minimally invasive flap formation procedure, the alveolar ridge was prepared (Fig. 7). In order to achieve a functional and aesthetic end result, the three-dimen- sional placement of the implant is of high importance. The implant shoulder should be two to three millimetres below the cementum-enamel junction of an adjacent tooth and displaced palatinal to a slight extent. In this way, the coronal emergence profile can be shaped in the best way to meet aesthetic criteria. According to these guidelines, the position of the implant was marked on the jawbone with a round bur (Fig. 8). The pilot hole was then drilled and the new three-dimensional position checked with paralleling pins. implants 1 2017 27