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Richard Zimmermann/Stefanie Seitz: Insertion of a Straumann® PURE Ceramic Implant through the DWOS Synergy™ workflow with immediate digital provisionalization

  The Straumann® PURE Ceramic Implant has a natural looking ivory color. This specific feature makes the implant look more like a natural tooth and it supports the clinician in cases of thin gingiva biotype or soft tissue recession. It has a monotype design based on features of the Straumann® Soft Tissue Level Standard Plus and Straumann® Bone Level Implants. (Product information by the manufacturer) PICTURE DOCUMENTATION Fig. 01 Virtual planning of PURE implant for site #12 using coDiagnostiX™. Fig. 02 Restoration design #12 PURE implant in Straumann® CARES® Visual software. Fig. 03 Surgical guide design in coDiagnostiX™. Fig. 04 Provisional design based on virtual position for the PURE implant. Note the software takes into account the abutment facets. Fig. 05 Product illustration Fig. 06 PURE position indicator in place for evaluation of osteotomy. Fig. 07 PURE and transfer piece showing the indicator dots used for orientation during placement. Fig. 08 PURE placed with tissue reapproximated to evaluate depth of shoulder. Fig. 09 Final placement of PURE implant. Fig. 10 One week follow up showing tissue response and modified provisional. Fig. 11 Transfer piece indicator dots were not properly centered on abutment facets preventing complete seating onto the PURE. INITIAL SITUATION A 30 year old female with non-contributory medical history presented to the clinic for evaluation of a maxillary edentulous site.  Review of her dental history revealed that tooth #12 (ADA) was lost due to failed endondontic therapy approximately a year ago during her pregnancy and she was now ready to have it replaced.  She presented with a high smile line, medium-scalloped gingiva with medium thickness and a desire not to have any metal in her oral cavity.  When discussing the various options regarding implant therapy, the patient was very interested in being evaluated for an all ceramic implant. On January 11, the FDA cleared the Straumann® PURE Ceramic Implant for use within the US.  Though new to the US, European case documentation has shown excellent osseointegration and soft tissue response.  The Straumann® PURE Ceramic Implant is a monotype style implant, meaning the abutment and implant body are one-piece. TREATMENT PLAN The patient was sent to get a computerized cone beam tomography (Morita, USA) of the area and digital diagnostic impressions were taken using an intra-oral scanner (3Shape Trios 3).  Once obtained, the DICOMs were imported into the implant planning software (coDiagnostiX™) while the scan files were imported into the laboratory software (Straumann® CARES® Visual) (Figs. 1,2). Since the Straumann® PURE Ceramic Implant are monobody in design and it is not recommend to modify the abutment, the DWOS Synergy™ workflow was utilized to virtually plan this case. DWOS Synergy™ provides real-time communication between the implant planning software (coDiagnostiX™) and the lab software (Straumann®CARES®Visual). This feature improves implant planning by allowing the visualization of the relationship between the proposed implant position and the proposed restoration.  Modifications made to the implant position or restoration design are immediately transferred to the other software, providing instantaneous feedback on how the modification of one affects the other. Of special interest in regard to the Straumann® PURE Ceramic Implant, is that one can design the restoration and ensure that the planned position will not require modification for restorative materials. Once the planning was complete, both the surgical guide and the provisional designs were sent off for fabrication. The guide was sent to a lab to be printed by an Objet30 OrthoDesk (Stratasys) while the provisional file was sent to Straumann Milling Center in Arlington to be fabricated out of polycon ae (PMMA) (Figs 3, 4). During the surgical planning utilizing the DWOS Synergy™ workflow, a Straumann® PURE Ceramic Implant (4.1x12mm) was selected with an abutment height of 5.5 mm. SURGICAL PROCEDURE The Straumann® PURE Ceramic Implant design is a combination of the tissue level and bone level implant – the neck of the implant mirrors the Straumann® Tissue Level implant while the implant body mimics the Straumann® Bone Level design (Fig. 5). As such, the surgical protocol for preparing the osteotomy for the PURE is the same as the corresponding Bone Level implant.  For this case a guide was used to prepare the osteotomy following the protocol set forth for Bone Level implants given by coDiagnostiX™. Though this case was performed with Straumann Guided Surgery (SGS), a small flap was made to ensure the desired position of the Straumann® PURE Ceramic Implant shoulder. SGS utilizes different combinations of sleeve positions, drill lengths and drill handles to prepare the osteotomy to the correct depth.  Sleeves can be placed at three different heights from the implant level (2, 4 or 6mm) based on the case and surgeons preference.  The combination of drill length (short, long or extra-long) and drill handle (1mm or 3mm) are determined by the implant planning software which provides the surgical protocol to use at time of surgery.  The Straumann® PURE Ceramic Implant system uses a series of “position indicators” that aid in ensuring the correct position of the implant during surgery.  Both abutment diameters and heights have corresponding position indicators that are placed into the osteotomy for evaluation (Fig. 6). Once the osteotomy has been prepared, typically a surgeon will use a “guided implant”, which has a unique driver, to ensure proper placement of the implant.  However, the Straumann® PURE Ceramic Implant currently does not have such a driver therefore the surgical guide was only used to prepare the osteotomy while implant placement was performed free-hand.  Bone quality was determined to be Type II. The Straumann® PURE Ceramic Implant comes with a separate transfer piece for placement which snaps into place much like the Tissue Level impression cap.  Three dots on the driver line up with a flat surface of the abutment portion of the implant and also indicate distance to the shoulder (1, 2 and 3mm).  The implant was placed without any incidence to the desired depth and position of the dots (Figs. 7-9). During the healing phase, a protective cap is placed over the abutment to protect it.  Since the patient was concerned with esthetics and has a high smile line, it was decided to place a provisional to provide more esthetic appearance.  The recommendation by Straumann not to immediately load a PURE implant was taken into account during the DWOS Synergy™ design session by eliminating occlusal and lateral contacts.  This provisional was then further modified at time of surgery by further reducing the anatomy and creating more of a custom healing abutment than immediate provisional. The provisional was cemented using temporary cement (TempBond, Kerr) and only two interrupted sutures were required to secure the flap.  At the one-week follow up the tissue was healing beautifully around the implant and the patient was scheduled for the final impression seven weeks out (Fig. 10). FINAL RESULT The patient was in slight discomfort following the surgery, but stated that this surgery was less painful than the previous extraction. She was pleased to have the modified provisional versus a dark space in her smile. CONCLUSION “AS IMPLANT THERAPY HAS EVOLVED, PATIENT EXPECTATIONS HAVE RISEN. THE DESIRE TO HAVE A NATURAL LOOKING, METAL-FREE RESTORATION IS INCREASING AS CAN BE SEEN BY THE DECREASE OF METAL SUBSTRUCTURES FOR CROWNS AND FRAMEWORKS AND THE INCREASE IN CERAMIC RESTORATIONS.” RICHARD ZIMMERMANN/STEFANIE SEITZ Since the Straumann® PURE Ceramic Implant endosteal portion is based on the Straumann® Bone Level design, it does not require additional surgical instruments or drilling protocols for placement while the specialized transfer piece comes with the implant.  When placing the driver onto the Straumann® PURE Ceramic Implant abutment care must be taken to align the indicator dots up with the facets, otherwise incomplete seating of the driver may occur (Fig. 11). As implant therapy has evolved, patient expectations have risen. The desire to have a natural looking, metal-free restoration is increasing as can be seen by the decrease of metal substructures for crowns and frameworks and the increase in ceramic restorations. While titanium can cause a graying of the tissues, the ivory coloring of the Straumann® PURE Ceramic Implant can provide a more esthetic outcome.  Another patient was ecstatic to have the option for a Straumann® PURE Ceramic Implant implant since her husband has a titanium implant in the anterior region and she can see the gray.  All ceramic implants have the potential to provide greater esthetic outcomes but do require more precise planning and placement. Initially one might consider the Straumann® PURE Ceramic Implant to be limited by design, to a degree it is, however the DWOS Synergy™ workflow can help to reduce the challenge of placing a monotype implant. RICHARD ZIMMERMANN DDS UT School of Dentistry, San Antonio/Texas STEFANIE SEITZ DDS UT School of Dentistry, San Antonio/Texas Clinical review The clinical facts behind the Straumann® PURE Ceramic Implant. Brochure Download the brochure for the Straumann® PURE Ceramic Implant. SUBSCRIBE Subscribe to our monthly STARGET newsletter to receive the latest news about implant dentistry. The post Richard Zimmermann/Stefanie Seitz: Insertion of a Straumann® PURE Ceramic Implant through the DWOS Synergy™ workflow with immediate digital provisionalization appeared first on STARGET COM.

Rising stars sought in YoungProAward 2016 – apply now!

  Straumann and botiss biomaterials are pleased to announce the opening of the YoungProAward in Regenerative Dentistry 2016 with the aim of fostering the development of young dental professionals in the field of regenerative dentistry and dental biomaterials research. We cordially invite applications for the 2016 Award, in the form of written abstracts presenting original work that contributes to the advancement of treatment/care or research in regenerative dentistry. Dissertations, projects or practical experience may form the basis of applications. Submissions will be judged by a peer panel in a blind review process. The jury comprises leading academics/clinicians, who are internationally renowned authorities in the field and recognized experts from the industry. The winning application will be selected on the basis of its clinical and/or scientific quality as judged from the abstract and submitted materials. The first “Straumann-botiss YoungProAward in Regenerative Dentistry” was presented on 4 December 2015 to Andreas Pabst, DMD,, at the botiss bone & tissue days event in Salzburg, Austria. Entitled “In-vitro and in-vivo characterization of biocompatibility and biomechanical properties of a new acellular collagen matrix (mucoderm®)”, Dr Pabst’s winning entry concerns research into the use of tissue-graft products for regenerating gum tissues. WHO? The Award is open to dental professionals, including practitioners, students, researchers etc., who are under the age of 35. WHEN? Deadline for entries is 30 June, 2016. HOW? Complete details and the application process can be found at www.straumann.com/youngproaward WHY? The winner will receive a cash prize of €10 000 as well as travel to, and participation at, the bone & tissue days World Congress Berlin 2016, 9-10 September where the Award will be presented, and announced to the media. The winner will present their abstract at the congress and it will be subsequently published on STARGET Digital. The post Rising stars sought in YoungProAward 2016 – apply now! appeared first on STARGET COM.

Clinical review: Straumann® PURE Ceramic Implant – more than pure esthetics

  Nowadays, patients are more esthetic and health conscious than ever before (Montero et al., 2014). Healthy-looking oral soft tissues and bright teeth are considered a prerequisite for a beautiful smile and self-esteem, adding directly to health-related quality of life (Bennadi and Reddy, 2013; Klages et al., 2004; Pithon et al., 2014). The Straumann® PURE Ceramic Implant is ivory-colored like a natural tooth root and provides a highly esthetic and metal-free alternative to implants made out of titanium. Did you know? The Straumann® PURE Ceramic Implant is the result of more than 9 years of research and development, with an investment of over 100,000 man hours. Strong and reliable Ceramic components have been used successfully in orthopedic surgery for over 35 years (Bhandari et al., 2011) and are also valued by the aerospace industry for their enhanced toughness and dimensional stability even in high temperatures. However, the stability of ceramic dental implants has long been questioned. To overcome these objections, Straumann® has established an innovative manufacturing process followed by a rigorous 100 % proof test in which every single Straumann® PURE Ceramic Implant is tested mechanically before leaving the production site. Here, forces that exceed the maximum human bite capability are applied, and only implants that pass the test are delivered to the dentist. The outstanding quality becomes evident when comparing the Straumann® PURE Ceramic Implants with other commercially available ceramic implants. The Straumann® PURE Ceramic Implant (∅ 4.1 mm and ∅ 3.3 mm) shows significantly higher resistance to forced rupture (Fig. 1). Forced rupture is the most frequent cause of ceramic implant failure. The reliability of the Straumann® PURE Ceramic Implant has been clinically verified in a multicenter study, where zero implant fractures were reported during a follow-up period of 24 months (Gahlert et al., 2015). Fig. 1: Static fracture strength tests according to ISO14801 show that Straumann® PURE Ceramic Implants have significantly higher resistance to forced rupture than competitor implants in reduced and regular ­diameter (data on file). Did you know? Static strenght vs. fatigue strength Static strength is the ultimate fracture resistance of the implant system. The higher the implant’s static strength, the lower the risk for rupture when e.g. accidentally biting on a hard nut piece. Fatigue strength is the long-term capability of the implant to withstand normal masticatory forces. Next to excellent static strength (Fig. 1), the Straumann® PURE Ceramic Implant exceeds the requirements of an extreme fatigue strength test that corresponds to over 20 years of implant use. Esthetics Most patients perceive a treatment as successful when they are satisfied with the overall dentofacial appearance after treatment. Unlike other white ceramics, Straumann® PURE Ceramic Implants are ivory-colored, which most closely resembles natural tooth roots – an advantage in patients with a thinner mucosal biotype or a high lip line smile (Bidra and Rungruanganunt, 2013; Gahlert et al., 2015; Jung et al., 2008). Did you know? Zirconium ≠ Zircon ≠ Zirconia! Zirconium is a grayish white metal Zircon is a mineral Zirconia (Zirconium dioxide, ZrO2) is a ceramic powder   The Straumann® PURE Ceramic Implant is made out of 100 % metal-free yttrium-stabilized Zirconia. Favorable soft tissue formation Zirconia shows a favorable formation of the epithelial attachments, as well as lower bacterial accumulation compared to titanium surfaces (Degidi et al., 2006; Institut Straumann AG, 2014b; Welander et al., 2008). This is an important observation since bacterial adhesion to implant surfaces can lead to bone loss in the tissues surrounding the implants (Lindquist et al., 1996). Studies were able to show lesser gingival recession after placement of zirconia implants (Tete et al., 2009), as well as excellent esthetic outcomes and papilla formation around the implant after 4 years follow-up (Fig. 2) (Gahlert et al., 2015; Kniha, 2014). Figs. 2a/2b: In this 29-year-old female patient, a vertical fracture of tooth 21 led to marginal inflammation, which was particularly noticeable due to the high smile line (A). Situation after implant at loading at 4 years (B). Courtesy of Dr. Michael Gahlert and Dr. Heinz Kniha. Did you know? Zirconia shows favorable formation of the epithelial attachments, as well as lower plaque adhesion compared to titanium surfaces. Clinically proven Surface modifications play an important role in the osseointegration process and thereby influence implant strength as well as aging resistance (Buser et al., 1991; Shalabi et al., 2006). The surface of the Straumann® PURE ceramic implant, Straumann® ZLA®, features a topography characterized by macro- and micro-roughness similar to the proven Straumann® SLA® surface (Fig. 3) (Bormann et al., 2012; Gahlert et al., 2012; Institut Straumann AG, 2011). With over 20 years of experience and more than 100 clinical and preclinical studies, the Straumann SLA® surface is one of the most successful and best clinically documented surfaces in dental implantology, with proven osseointegration properties (Buser et al., 2012; Fischer and Stenberg, 2011; Roccuzzo et al., 2008). In preclinical studies, the ZLA® surface demonstrated similar healing patterns, healing times and osseointegration in terms of peri-implant bone density and bone-to-implant contact (BIC) as seen for the SLA® surface (Gahlert et al., 2012; Gahlert et al., 2010). Other studies observed even higher BIC with ceramic implants compared to titanium (Dubruille et al., 1999; Schultze-Mosgau et al., 2000). A recent multicenter clinical trial reported survival and success rates of 97.6 % for the Straumann® PURE Ceramic Implant after one year (Gahlert et al., 2015), which is a value within the range of reported one-year survival and success rates for titanium or titanium alloy implants (den Hartog L. et al., 2008). Fig. 3A/B: The ZLA® surface (A) combines the micro- and macro-roughness of the SLA® surface (B) with reliable osseointegrative properties. The torque-out value of the Straumann® PURE Ceramic Implant is equivalent to SLA® implants from titanium. Metal-free The prevalence of allergic diseases has increased worldwide in recent years (Lotvall et al., 2012), with a growing number of patients suffering from multiple allergies (Simpson et al., 2008). Although hypersensitization to titanium is quite uncommon (Sicilia et al., 2008), many people are generally aware of allergic reactions to metals such as nickel and cobalt (Thyssen and Menne, 2010). In this light, health-conscious patients or patients with susceptibility to allergic reactions may request a metal-free alternative to titanium implants. Straumann® PURE Ceramic Implants are made out of zirconia (yttria-stabilized tetragonal zirconia polycrystal, Y-TZP), which is biocompatible and guaranteed 100 % metal-free. Did you know? Patients prefer metal-free. A recent patient survey in Germany and Switzerland involving more than 250 participants revealed that patients would prefer a light-colored ceramic implant over a grayish colored titanium implant, even if it involves higher treatment costs (Institut Straumann AG, 2014c). REFERENCES 1 Bennadi D, Reddy CV (2013). J Int Soc Prev Community Dent 3(1):1-6. Bhandari M, Peter M.Lewis, James P.Waddell (2011). Evidence-Based Orthopedics . Oxford, UK: Wiley-Blackwell. 2 Bidra AS, Rungruanganunt P (2013). J Esthet Restor Dent 25(3):159-176. 3 Bormann KH, Gellrich NC, Kniha H, Dard M, Wieland M, Gahlert M (2012). Clin Oral Implants Res 23(10):1210-1216. 4 Buser D, Janner SF, Wittneben JG, Bragger U, Ramseier CA, Salvi GE (2012). Clin Implant Dent Relat Res 14(6):839-851. Buser D, Schenk RK, Steinemann S, Fiorellini JP, Fox CH, Stich H (1991). J Biomed Mater Res 25(7):889-902.5 Degidi M, Artese L, Scarano A, Perrotti V, Gehrke P, Piattelli A (2006). J Periodontol 77(1):73-80. 6 den Hartog L., Slater JJ, Vissink A, Meijer HJ, Raghoebar GM (2008). J Clin Periodontol 35(12):1073-1086. 7 Dubruille JH, Viguier E, Le NG, Dubruille MT, Auriol M, Le CY (1999). Int J Oral Maxillofac Implants 14(2):271-277. 8 Fischer K, Stenberg T (2011). Clin Implant Dent Relat Res. 9 Gahlert M, Kniha H, Weingart D, Schild S, Gellrich NC, Bormann KH (2015). submitted. 10 Gahlert M, Roehling S, Sprecher CM, Kniha H, Milz S, Bormann K (2012). Clin Oral Implants Res 23(3):281-286.11 Gahlert M, Rohling S, Wieland M, Eichhorn S, Kuchenhoff H, Kniha H (2010). Clin Implant Dent Relat Res 12(4):297-305. 12 Institut Straumann AG (2011). Preclinical evaluation report. Data on file 13 Institut Straumann AG (2014b). Data on File. 14 Institut Straumann AG (2014c). Patient Survey. Data on File. 15 Jung RE, Holderegger C, Sailer I, Khraisat A, Suter A, Hammerle CH (2008). Int J Periodontics Restorative Dent 28(4):357-365. 16 Klages U, Bruckner A, Zentner A (2004). Eur J Orthod 26(5):507-514. 17 Kniha K (2014). ITI World Symposium, Geneva. 18 Lindquist LW, Carlsson GE, Jemt T (1996). Clin Oral Implants Res 7(4):329-336. 19 Lotvall J, et al. (2012). Allergy 67(4):449-450. 20 Montero J, Gomez-Polo C, Santos JA, Portillo M, Lorenzo MC, Albaladejo A (2014). J Oral Rehabil 41(10):768-782. 21 Pithon MM, Nascimento CC, Barbosa GC, Coqueiro RS (2014). Am J Orthod Dentofacial Orthop 146(4):423-429. 22 Roccuzzo M, Aglietta M, Bunino M, Bonino L (2008). Clin Oral Implants Res 19(2):148-152. 23 Schultze-Mosgau S, Schliephake H, Radespiel-Troger M, Neukam FW (2000). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89(1):91-98. Shalabi MM, Wolke JG, Jansen JA (2006). Clin Oral Implants Res 17(2):172-178. Sicilia A, Cuesta S, Coma G, Arregui I, Guisasola C, Ruiz E et al. (2008). Clin Oral Implants Res 19(8):823-835. 24 Simpson CR, Newton J, Hippisley-Cox J, Sheikh A (2008). J R Soc Med 101(11):558-563. 25 Tete S, Mastrangelo F, Bianchi A, Zizzari V, Scarano A (2009). Int J Oral Maxillofac Implants 24(1):52-58. 26 Thyssen JP, Menne T (2010). Chem Res Toxicol 23(2):309-318. Welander M, Abrahamsson I, Berglundh T (2008). Clin Oral Implants Res 19(7):635-641. The post Clinical review: Straumann® PURE Ceramic Implant – more than pure esthetics appeared first on STARGET COM.

Roberto Sleiter/Nathalie Oppliger: Mandible restoration with BLT implants and screw-retained abutments in a dental phobic patient with very poor dentition (Straumann® Pro Arch)

  The Straumann® Pro Arch solution provides a safe, reliable and less complex treatment option for patients requiring full-arch treatments. Patients and clinicians benefit from the combination of the individualized prosthetics and the surgical advantages of the SLActive®/ Roxolid® combination. The concept of Straumann® Pro Arch is based on a fixed rehabilitation which encompasses the whole procedure from removal of hopeless teeth, immediate placement of four implants and immediate loading of the implants with a temporary bridge. It also includes the treatment planning steps before surgery and afterwards when converting the temporary bridge to the final full-arch prosthesis. (Information by the manufacturer) PICTURE DOCUMENTATION Fig. 01 sleiter01 Fig. 02 sleiter02 Fig. 03 sleiter03 Fig. 04 sleiter04 Fig. 05 sleiter05 Fig. 06 sleiter06 Fig. 07 sleiter07 Fig. 08 sleiter08 Fig. 09 sleiter09 Fig. 10 sleiter10 Fig. 11 sleiter11 Fig. 12 sleiter12 Fig. 13 sleiter13 Fig. 14 sleiter14 Fig. 15 sleiter15 Fig. 16 sleiter16 Fig. 01 Virtual planning of PURE implant for site #12 using coDiagnostiX™. Background: The Straumann AID programme Straumann AID (Access to Implant Dentistry) is a global initiative. The necessary materials for an implant restoration are provided by Straumann free of charge to offer assistance in certain cases to patients who lack the financial means.  In the present case, the patient was in receipt of a disability pension, and therefore had very limited finances. Under these circumstances, an appropriately comprehensive and satisfactory restoration was impossible. Thanks to Straumann AID and the fee waiver by Dr. Sleiter’s practice (surgical and prosthetic treatment costs) and the dental lab (Jenni Dental Laboratory, Fulenbach, Switzerland), we were able to offer this patient a fixed mandibular restoration to re-establish his dental function. A new complete denture was also made for the maxilla.  The final result showed significant improvement, both in aesthetics and function. INITIAL SITUATION A 45-year-old dental phobic patient with very poor dentition, who had not visited a dentist for over 10 years, came to our practice (Fig. 1) requesting remedial work. The complete maxillary denture proved to have an inadequate hold and very poor aesthetic appearance. The patient’s remaining mandibular dentition had multiple caries profunda or cervical caries and apical periodontitis. The patient was a disability pension recipient and therefore his finances were very limited. TREATMENT PLAN Thanks to the materials provided by the “Straumann Access to Implant Dentistry” programme (“Straumann AID”) and the fact that the authors and the laboratory waived their fees, we were able to offer our patient a complete maxillary denture and a fixed mandibular restoration. First, a new complete denture was made for the maxilla. The patient demonstrated a high level of acceptance during the course of the initial appointments, and therefore the decision was made to fit a fixed mandibular restoration in accordance with the Straumann® Pro Arch concept. This provides for a fixed prosthetic solution which is achieved by extracting the remaining teeth with immediate insertion and immediate loading of at least 4 implants. Due to the above-mentioned very poor condition of the mandibular dentition which is clear in the OPT (Fig. 2) and the questionable prognosis for some teeth, it was decided that the teeth in the lower jaw should be extracted. The treatment is divided into two phases, during each of which the patient receives a temporary restoration and a definitive restoration. The temporary restoration is directly screwed in immediately following implantation, allowing the immediate restoration of function and aesthetics. The definitive restoration involves optimising function and aesthetics after the implants are given time to heal (approximately 2 months). SURGICAL PROCEDURE All the remaining teeth in the lower jaw were removed, and bone smoothing was performed at the same time as the implantation (Fig. 3). 4 Straumann® Bone Level Tapered (BLT) implants made of Roxolid® (∅ 4.1, SLActive®, 10mm and 12mm) were used. The 12mm implants were set in regions 32 and 42, and the 10mm implants in regions 35 and 45 (Fig. 3). Thanks to the favourable bone situation in the lower jaw, it was possible to set the implants in parallel (Fig. 4), all of which had adequate primary stability so the decision was made to carry out immediate loading. PROSTHETIC PROCEDURE A diagnostic splint was used to select the perfect screwed abutments (Fig. 5). In this case, the axes of the implants were so good that no angled abutments had to be used. Thus only 0° abutments were used, which were tightened with 35 Ncm (Fig. 6). In turn, the height of the screwed abutments (available in 1, 2.5 and 4 mm) was selected in accordance with the peri-implant mucosa and the bone level. It was necessary to ensure that the screwed abutments would end up lying epimucosally when the mucosa were adapted. These could be substituted for the final restoration, if the height or angle were not ideal. The protective RC caps (Fig. 7) were manually tightened to the screwed abutments with about 10-15Ncm, and the mucosa were adapted and sutured. The temporary restoration was released amply at a basal level from 35 to 45, following which the complete maxillary denture was used together with a prefabricated silicone bite and the temporary prosthesis filled with silicone (3M ESPE Imprint 4 Bite) in order to determine the intermaxillary relations in the patient’s mouth (Fig. 8). In order to guarantee correct intermaxillary relations, it is important to ensure that the protective caps are not pushed through the silicone. A temporary prosthesis was made for the lower jaw to fit perfectly with the new complete maxillary denture, and also doubled as an operation splint for diagnosis. A bilateral balanced occlusion was selected for the occlusion design, ensuring the functional stability of the complete maxillary denture. Subsequently, the protective caps were removed and an impression of the implants was taken using impression posts. These were screwed directly on to the screwed abutments (Fig. 9). The impression was performed using Impregum (3M ESPE) (Fig. 10). The temporary fixed restoration was incorporated in the lower jaw after just a few hours, following the principle of immediate loading (Fig. 11), with a follow-up appointment to remove the sutures one week later. FINAL RESULT After allowing a 3-month healing period for the implants, an impression of the lower jaw was taken for the definitive restoration. To this end, the impression posts were screwed directly onto the abutments. Bite registration was performed in the conventional manner with a wax rim and the tooth set-up was tried on in wax. Thereafter, a CAD/CAM titanium framework was prepared to support the prosthetic teeth. The passive seat of the framework was assessed before the work was completed. The completed restoration (Figs. 12, 13) was tightened with 15 Ncm and the screw channels sealed with Teflon and composite in order to enable possible reintervention. The patient was given instructions on daily cleaning of the fixed restoration with Superfloss and Plack Out gel (Fig. 14). After insertion of the work, there were two follow-up checks, including OPT (Fig. 15). Since then, the patient has attended recall consultations (Fig. 16) twice a year. CONCLUSION “THE PATIENT WAS ABLE TO LEAVE THE PRACTICE WITH A TEMPORARY FIXED RESTORATION WITHIN A FEW HOURS.” Thanks to the Straumann® Pro Arch concept with the new Straumann® Bone Level Tapered implants (BLT), the SLActive® surface (which generates rapid healing of the implants), as well as the large choice of screwed abutments (height and angulation), we were able to provide the patient with an ideal fixed solution within the shortest time possible. Due to the experience of the practitioners and the ideal, close cooperative relationship with the dental laboratory, all the prerequisites for a smooth and successful process were in place, so the patient was able to leave the practice with a temporary fixed restoration within a few hours. Overall, from insertion of the implant to the second follow-up check on the final restoration, the patient only attended 8 appointments and within 5 months he was fitted with his final maxillary and mandibular restoration. ROBERTO SLEITER DR. MED. DENT. Studied dental medicine at the Università Cattolica in Rome, Italy. Specialist in oral surgery (since 2002). Private practice in Egerkingen, Switzerland. External Senior Physician at the Department of Oral Surgery at the University of Bern, Switzerland with Prof. Daniel Buser. Member of the Swiss Dental Association (SSO), the Swiss Society of Oral Surgery and Stomatology (SSOS) and the Swiss Society of Oral Implantology (SGI). NATHALIE OPPLIGER DR. MED. DENT. Studied dental medicine at the University of Basel, Switzerland. Trained at the Clinic for Reconstructive Dentistry and Myoarthropathy, University of Basel. Dentist in the practice of Dr. Roberto Sleiter, Egerkingen.­ Clinical review The clinical facts behind the Straumann Pro Arch® Solution. Brochure Download the brochure for the Straumann Pro Arch® Solution. The post Roberto Sleiter/Nathalie Oppliger: Mandible restoration with BLT implants and screw-retained abutments in a dental phobic patient with very poor dentition (Straumann® Pro Arch) appeared first on STARGET COM.

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