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ePaper created 2017-11-09, 09:28:26 | version 1.38.0
| industry Fig. 9 Fig. 10 Fig. 11 Figs. 9–11: Pilot drill, paralleling pins, enlargement drilling and threading. The pilot hole was drilled subsequent to the implant site being enlarged with a form drill (S 2.9 mm, M 3.4 mm). In order to avoid the potential increase in pressure that may arise when the implant is being inserted into the bone, we also used a thread cutter (Figs. 9–11). In order to avoid necrosis, the implant has to be inserted into the hole at a slower pace than a titanium implant, as zirco- nium dioxide is a poor conductor of heat. The implant used here was fixed in place in the implant site by hand, by making a few turns using an insertion device that had been taken out of sterile packaging and connected to a rachet adapter. Subsequently, it was manually inserted deep into the hole (Figs. 12–15). By using the hexalobe joint modified specially for use with the ceramic implant, the insertion tool was guided into the implant in an optimal fashion. The protocol specified a maximum of 15 revolutions per second and a torque of 35 Ncm. The shoulder was placed at 1.5 mm in a supracrestal position so that the prosthetic platform would be located around 0.5 mm under the soft tissue. This position corresponds to where the smooth ZrO2 surface changes to have a coarse texture at the level of the bone. To enable open integration, the implant is sealed used a healing cap and the soft tissue is adap- tively sewn using a 6-0 suture (Figs. 16–18). Prosthetic restoration Prosthetic restoration takes place after the four-month integration phase. The healing cap is removed with a screw driver and an impression is made with the pins for the open tray technique (Figs. 19–21). Dental technicians created a master model in a laboratory. The lab analogue (PEEK) was attached to the impression post using a screw, then the model was emptied and mounted on the articulator. The technician marked the anatomical coro- nal emergence profile on the plaster model and, using a bur, milled the profile up to the lab analogue (Fig. 22). Subsequently, the PEKK abutment was scanned and an occlusal screw-retained hybrid crown was designed from zirconium dioxide, which was then veneered buccally. Af- ter checking the aesthetics, the crown was cemented to the PEKK abutment with a Multilink Hybrid Abutment (Ivoclar Vivadent; Figs. 23 & 24). Before the crown was integrated into the mouth, im- plant stability was checked using Osstell ISQ and an X-ray image was produced.10, 12, 13 When the PEEK gin- giva former was removed, a peri-implant gingiva free from irritation could be seen (Figs. 25–27). The hybrid abutment crown was inserted and screwed in place using a titanium screw with 25 Ncm (Figs. 28–30). As the high-performance polymer is not X-ray opaque, an uninterrupted gap of around 1 mm can be seen at the point of the implant-abutment crossover in the X-ray image (Fig. 31). The channel where the screw entered was sealed with Teflon tape and a light-curing composite after the functional check-up. Figure 32 shows the clinical situa- tion one year after the prosthetic restoration took place. The crown blends in with the row of teeth perfectly. The papillae are solid and pointed, closing the interdental spaces. The patient was happy about the successful and “invisible” treatment she received with implant prosthetics. Discussion The two-part ceramic implant used in the case outlined above (CERALOG Hexalobe, CAMLOG) is an alternative to a titanium implant. It osseointegrates and is used for patients who want a metal-free, aesthetic solution. The implant can be used both supracrestally and epicrestally. In general, the primary indications for CERALOG implants are fixed single tooth crowns and three-part bridge res- torations without extensions. In terms of the latest devel- opments, there are limitations in the domain of removable treatment concepts. CERALOG implants are produced in a ceramic injection moulding process, whereby after having been injection moulded, the implants are then subjected to a sintering 28 implants 1 2017