“Despite the complications in this case, resulting in the need to activate the implant on the eighteenth day post-placement, the Bone Level Roxolid® SLActive® provided a very satisfactory outcome, demonstrating its stability, superior strength and surface treatment, even under extreme circumstances.” Dr. André Callegari PRODUCT INFORMATION BY THE MANUFACTURER Straumann CARES® Digital Solutions Straumann® Variobase Straumann CARES® Digital Solutions We are continuously evolving our product portfolio to match the needs of your daily practice in a fast changing market environment. “CARES” stands for “Computer Aided REstoration Solutions” and delivers a complete digital dentistry workflow solution tailored to your needs – reliable, precise, and digitally validated, from scan to manufacture. Find out more. Straumann® Variobase Straumann Variobase® provides dental laboratories with the flexibility to create customized abutments through their preferred workflow. In addition, it comes with the benefit of the original Straumann connection and the unique Straumann engaging mechanism. SLActive®, Bone Control Design™, CrossFit® connection, prosthetic diversity, plus a tapered implant body. Learn more PICTURE DOCUMENTATION Fig. 1 callegari01 Fig. 2 callegari02 Fig. 3 callegari03 Fig. 4 callegari04 Fig. 5 callegari05 Fig. 6 callegari06 Fig. 7 callegari07 Fig. 8 callegari08 Fig. 9 callegari09 Fig. 10 callegari10 Fig. 11 callegari11 Fig. 12 callegari12 Fig. 13 callegari13 Fig. 14 callegari14 Fig. 15 callegari15 Fig. 16 callegari16 Fig. 17 callegari17 Fig. 18 callegari18 Fig. 19 callegari19 Fig. 20 callegari20 Fig. 21 callegari21 Fig. 22 callegari22 Fig. 23 callegari23 Fig. 24 callegari24 Fig. 25 callegari25 INITIAL SITUATION A 21-year-old male patient presented to the Clinic Beleza do Sorriso in São Paulo, Brazil, with a fractured element 21. He was dissatisfied with the esthetics in the anterior segment of the maxilla and had multiple active carious lesions in the interproximal regions of teeth 11, 12 and 22 (Figs. 1,2). TREATMENT PLANNING The aim of planning is to set out a path to ensure the best possible outcome for a specific goal. In high performance dentistry, diagnosis and treatment planning are key elements of success. The first step in this case was to evaluate the patient’s medical history and to confirm that he was in good general health. When starting any esthetic rehabilitation treatment, a number of aspects must be considered: bone architecture, periodontal biotype, interproximal bone crest level and smile line. Plaster study models were then created, which, along with photographic documentation and imaging examinations, helped to identify the root fracture on tooth 21 and slight buccal bone loss. We used the concept DRP (Digital Reverse Planning) which allows full virtual planning, from the bone defect arising from the tooth extraction up to the final outcome of the ideal three-dimensional positioning of the implant in order to obtain the desired esthetic result. We opted for the extraction of tooth 21 and immediate implant placement. All the necessary information obtained through tomography was transferred to the software and a virtual guide was accurately designed. The customized guide was milled without metal washers and based on precise measurements so as to ensure precision placement of the Bone Level Roxolid® SLActive® 3.3 x 14mm implant (Figs. 3-5). After placement, the implant was immediately temporized; the adjacent decayed teeth were properly cleaned and prepared for ceramic fragments in order to correct dental rotations and enhance the esthetics of the anterior region. SURGICAL PROCEDURE The planning of the immediate implant enables us to reduce treatment time, leading to greater patient satisfaction and less bone resorption, as well as optimizing function and esthetics from the very first surgical step. In order to achieve successful implant treatments, a review of the literature shows that minimally traumatic surgery is essential, thus preserving the alveolar architecture and surrounding soft tissue.After probing the proximal bone crests, we performed the extraction of tooth 21 and careful socket curettage. The customized surgical guide was adapted and stabilized (Fig. 6); the placement followed the predetermined position and recommended torque for the Bone Level Roxolid® SLActive® implant, selected for the combination of Roxolid® material and the SLActive® surface that increases the resistance for small diameter implants. This provides greater confidence and peace of mind for the resolution of anatomically challenging cases. The occlusal adjustment is a crucial step for a predictable case outcome, to ensure that forces are not transmitted to the implant sooner than expected, thus compromising the final result of the procedure. The patient must receive proper instruction in hygiene and postoperative care (Figs. 7-9). UNEXPECTED SITUATION Unexpectedly, 18 days after the implant placement, the patient had a cut-contusion lesion with loss of substance of the lower lip. He reported having undergone direct physical assault with a blunt object. The examination showed considerable mobility of the provisional implant prosthesis, albeit without signs of inflammation in the region. The provisional prosthesis was removed and, to our pleasant surprise, it was found that implant stability had been maintained and only the prosthesis screw had loosened due to the trauma suffered. Immediately, in a single step, we proceeded with the preparation of the ceramic prosthetic parts and the impression of the whole region, including the implant, as described below (Figs. 10,11). PROSTHETIC PROCEDURE The excellent treatment surface of the Roxolid® SLActive® implant allows definitive implant activation to be initiated within 21 days. In this case, however, due to the circumstances, the rehabilitation procedures began at 18 days. Ceramic fragments were prepared for teeth 12, 11 and 21 with diamond drills and ultrasonic tips; tissue control was carried out in the region and the impression post was installed on the implant and customized, so that the surrounding soft tissue could be accurately reproduced (Figs. 12,13). The CADCAM system technology allows amazing accuracy, providing better functional and economic benefits to patients. The implant prosthesis was made following the CARES® approach on the Straumann® Variobase® abutment, which allows exact engagement of the coping to the Straumann® Variobase® abutment with its four engaging grooves. For scanning and modelling of the case, the Dental Wings platform was used to design the implant prosthesis and the ceramic for the adjacent teeth (Figs. 14,15). The milling was done in zirconia for later application of ceramic coverage, characterization and customization of the elements. The parts were tested in the mouth and, after adjustment, were properly etched and cemented (Figs. 16-21). FINAL RESULT 4 months’ follow-up; stable surrounding tissues and occlusion; satisfied patient and satisfactory radiographic appearance (Figs. 22-25). André Callegari André Callegari is a specialist in dental prosthetics, currently studying for his PhD in Dentistry. He is a founding partner of the Clinic Beleza do Sorriso, in São Paulo, Brazil and coordinator and author of the books Especialidade em foco, vol. 1 and vol. 2 Ed. Napoleão. The post André Callegari: Immediate placement of Straumann® Bone Level Roxolid® SLActive® implant in esthetic zone, followed by final restoration using Straumann® CARES® Digital Solutions appeared first on STARGET COM.
“This case utilizing n!ce™ was, in fact, nice. It achieved an excellent clinical result, and more restorations, including traditional fixed restorations, are planned for the future.” Dr. Stefanie Seitz PRODUCT INFORMATION BY THE MANUFACTURER Straumann® n!ce™ is Straumann’s fully crystallized glass-ceramic. Building on our technological experience of six decades, we offer this innovative glass-ceramic material that is pleasantly simple, safe, and user-friendly. This approach combines biocompatibility and esthetics to create novel, fully crystallized milling blocks that can be ground, polished and fitted without the need for additional crystallization firing, thus saving substantial time and effort. Turn time spent milling into time spent smiling. 😉 PICTURE DOCUMENTATION Fig. 1 seitz01 Fig. 2 seitz02 Fig. 3 seitz03 Fig. 4 seitz04 Fig. 5 seitz05 Fig. 6 seitz06 Fig. 7 seitz07 Fig. 8 seitz08 Fig. 9 seitz09 CASE REPORT A 51-year-old Caucasian male, non-smoker in good general health presented to the clinic for restoration of #5 with a Straumann® Bone Level RC implant. The patient presented with a low smile line, thick keratinized tissue and moderate esthetic concerns. It was decided that a cement-retained n!ce™ restoration on a custom abutment would be used as the final restoration. The n!ce™ material is a lithium disilicate strengthened lithium aluminosilicate glass-ceramic, and was chosen due to its excellent mechanical properties and esthetics. PROSTHODONTIC PROCEDURE During the initial appointment, the final impression was made utilizing the open tray technique, and a soft tissue cast was subsequently fabricated. The master cast was then digitally scanned and imported into Straumann® CARES®, where both the custom abutment and final crown were designed using the X-Stream® (Straumann) workflow (Figs. 1-3). Both designs were sent to the Straumann milling center in Arlington, Texas for production. After fabrication, n!ce™ has a dull, opaque appearance (Fig. 4). However, once the material is polished, the esthetics become greatly enhanced, and the restoration acquires a more lifelike appearance and better matches the selected shade (Fig. 5). Close examination of the restoration revealed accurately milled margins without any chipping or fractures (Fig. 6). At the second appointment, the abutment was placed, with the final screw torqued to 35Ncm following the manufacturer’s directions (Fig. 7). Teflon tape and composite were used to cover the screw channel. The n!ce™ crown was then tried in and required slight interproximal and occlusal adjustments, although the internal fit was perfect (Fig. 8). After polishing, it was decided to add some characterization to better blend in with the adjacent teeth. Comparing the initial unfinished crown with the final crown demonstrates that this material’s inherent esthetic qualities allowed for minimal finishing and polishing to accomplish the desired result (Fig. 9). The final restoration was cemented to the abutment using a resin-modified glass ionomer cement. The patient was very pleased with the fact that the metal abutment could not be visualized through the crown and commented on its natural appearance. RESULT The esthetic properties of n!ce™ clearly make it a desirable material for restorations due to its display of natural-looking translucency while masking the grey of the underlying abutment. Additional properties make it even more desirable, including the fact that no additional sintering/crystallization firing of the restoration is required, decreasing the total amount of time needed to finish it prior to delivery. This is a huge advantage when considering that this material is available for chairside milling in private offices. In addition, this material is simple and quick to polish, or it can be stained and glazed to enhance the esthetics. This case utilizing n!ce™ was, in fact, nice. It achieved an excellent clinical result, and more restorations, including traditional fixed restorations, are planned for the future. STEFANIE D. SEITZ DDS Dr. Seitz earned her dental degree from The University of Texas Health Science Center at San Antonio in 2003. She maintained a private practice until 2011 and has been an Assistant Clinical Professor in the Department of Comprehensive Dentistry at University of Texas Health Science Center at San Antonio since 2003. She helped establish the Digital Dentistry program for the undergraduate dental students in 2011 and currently directs the clinical and pre-clinical integration of CADCAM technology into the pre-doctorate curriculum. Dr. Seitz has received significant training in various CADCAM chairside materials, with special focus on lithium disilicate. From simple extrinsic staining to porcelain layering, her experience and knowledge with the various esthetic blocks have resulted in various publications and presentations at national meetings. The post Stefanie Seitz: Application of the Straumann® n!ce™ glass ceramic material for a single crown restoration in the maxilla appeared first on STARGET COM.
This case shows that, while it is necessary to continue to deepen and analyze this procedure in the long term, the results obtained to date are equivalent to, or more favorable than, those achieved when procedures are performed in stages. These results have been very motivating to continue to deepen this therapeutic strategy. The procedure offers the main advantages of exposing the patient to fewer surgical procedures, a reduction in maneuvers and prosthetic sessions, with a consequent decrease in clinical time and total treatment time. This technique requires extensive training as it is very technique sensitive due to the importance of the 3D implant position, the volume of soft and hard tissues and the prosthesis design. PRODUCT INFORMATION BY THE MANUFACTURER Straumann® Bone Level Tapered Implant Straumann® Variobase Straumann® Bone Level Tapered Implant The Straumann® Bone Level Tapered Implant offers excellent primary stability in soft bone and fresh extraction sockets. The tapered form adequately compresses the underprepared osteotomy. It also allows to effecively master your patient’s limited anatomy such as facial undercut, converging root tips, concave jaw structure or narrow atrophied ridges. Building on the clinically proven features of the Straumann® Bone Level Implant, the BLT introduces the powerful combination of Roxolid®, SLActive®, Bone Control Design™, CrossFit® connection, prosthetic diversity, plus a tapered implant body. Learn more Straumann® Variobase Straumann Variobase® provides dental laboratories with the flexibility to create customized abutments through their preferred workflow. In addition, it comes with the benefit of the original Straumann connection and the unique Straumann engaging mechanism. SLActive®, Bone Control Design™, CrossFit® connection, prosthetic diversity, plus a tapered implant body. Learn more PICTURE DOCUMENTATION Fig. 1 losada01 Fig. 2 losada02 Fig. 3 losada03 Fig. 4 losada04 Fig. 5 losada05 Fig. 6 losada06 Fig. 7 losada07 Fig. 8 losada08 Fig. 9 losada09 Fig. 10 losada10 Fig. 11 losada11 Fig. 12 losada12 Fig. 13 losada13 Fig. 14 losada14 Fig. 15 losada15 Fig. 16 losada16 Fig. 17 losada17 Fig. 18 losada18 INITIAL SITUATION The 28-year-old male patient came to our practice with no general health conditions or habits that could affect the prognosis of our treatment. After clinical examination (Fig. 1) (periapical x ray, probing, CBCT scan), a vertical root fracture was diagnosed, accompanied by a defect on the buccal and palatal walls. Various treatment options were presented and discussed together with the patient, and he decided to have tooth 21 replaced with an implant. As his oral hygiene was poor, basic periodontal therapy was performed and plaque control was evaluated weekly for one month. TREATMENT PLANNING After careful examination of the residual bone on the CBCT scan (Figs. 2,3) we decided to opt for an immediate implant, as we believed that primary stability and high insertion torque could be obtained using the Straumann® Bone Level Tapered (BLT) Implant. Accordingly, we planned to proceed to immediate provisionalization with the patient´s own crown, and produced a silicone index so that the crown could then be repositioned in its original exact location after the extraction. Antibiotic therapy was prescribed and consisted of 1g of amoxicillin with clavulanate one hour before surgery, followed by 500mg every 8 hours for a week. SURGICAL PROCEDURE Tooth 21 was extracted carefully (Fig. 4), ensuring that the papillae and soft tissue contours remained intact. In order to minimize bone resorption and keep both the bone and soft tissue graft stable, a flap was not raised. Granulation tissue was removed and socket irrigation was performed with CHX2%. The implant bed was prepared for a ∅ 4.1 mm Straumann® BLT Implant (Roxolid® SLA® 4.1×12 mm). The implant was placed towards the palatal side of the socket, leaving a 2.5mm gap and 3.5mm in depth from our ideal gingival margin (Fig. 5). We prepared the provisional using a temporary long-term abutment and the patient’s own crown with the help of a silicone key to reposition the crown in its original exact location. The gap was filled with xenogenic bone graft, and we placed a connective tissue graft from the anterior palate with an envelope technique. The envelope was prepared with a sclerotome (sharp point). The temporary crown was screwed, and all occlusal contacts during centric and eccentric movements were eliminated (Fig. 6). Sutures were removed after 10 days (Figs. 7,8). PROSTHETIC PROCEDURE Osseointegration was checked after 10 weeks (Figs. 9,10). A customized impression transfer was created following the provisional contour (Figs. 11-13). The lab prepared the final restoration using a veneered zirconia crown (GC Initial) on the Straumann® Variobase® abutment (Figs. 14-16). FINAL RESULT In our practice we believe that immediate implants offer numerous advantages over conventional implants in terms of treatment duration, number of surgeries, morbidity and esthetic outcome. In this particular case, the patient benefited both from the standpoint of time and esthetic outcome (Figs. 17,18). We believe that it is not necessary to keep the buccal wall intact in order to place an immediate implant as, in most cases where the buccal wall is present, it will resorb within a short period of time as it is usually formed from bundle bone exclusively. We already know from the literature that bundle bone is dependent on the periodontal ligament and will disappear following extraction of the tooth. We believe that non-resorbed bone peaks from the neighboring teeth, followed by a good surgical technique with soft and hard tissue graft and immediate provisionalization, will guide the healing in a proper way to produce predictable results. José Manuel Losada Graduated in dental medicine in Madrid, Spain. Trained as a specialist in endodontics in Buenos Aries, Argentina and as a specialist in oral surgery and implantology in Principe de Asturias hospital, Madrid, Spain. Assistant professor of implantology in the postgraduate program of Principe de Asturias hospital. www.drlosada.com The post José Manuel Losada: Post extraction implant placement with bone and soft tissue graft combined with immediate provisionalization in a damaged socket (BLT/Variobase) appeared first on STARGET COM.
In this case, the patient refused to have the bone volume increased by means of a block graft or GBR technique in a two-step approach. Therefore she was offered a less invasive protocol with a single surgical step and a minimally invasive flap, GBR and use of botiss mucoderm® for horizontal tissue augmentation. PRODUCT INFORMATION BY THE MANUFACTURER Straumann® Bone Level Implant Mucoderm® – a three dimensional collagen matrix Straumann® Bone Level Implant The Straumann® Bone Level Implant line was designed for a natural look and feel, providing flexibility and a balanced prosthetic portfolio for every indication. It enables for esthetically pleasing solutions, featuring important technical and biological concepts (Crossfit® connection, Consistent Emerging Profiles™, Bone Control Design™, Loxim™). It is available from Roxolid® and SLActive® and with the SLActive® or SLA® surfaces. By using the same surgical and prosthetic kit as the Straumann® Soft Tissue Level Implant line, the Bone Level Implant is the perfect addition to the Straumann® Dental Implant System, offering unmatched treatment flexibility and options. More articles Mucoderm® – a three dimensional collagen matrix Another innovative product from the botiss portfolio is mucoderm®, which is made from porcine dermis, developed for soft tissue augmentation. The complex collagen structure serves as a scaffold for ingrowing vessels and soft tissue cells, and is gradually remodeled into the patient’s own tissue. The application of mucoderm® circumvents the need for harvesting autologous gingival or subepithelial transplants during recessions coverage, regeneration of soft tissue defects and augmentation of attached gingiva. Accordingly, post-operative pain and risk of complications may be reduced, while the patient’s acceptance of the surgical intervention may increase. More articles VIDEO DOCUMENTATION PICTURE DOCUMENTATION Fig. 1 pandolfi01 Fig. 2 pandolfi02 Fig. 3 pandolfi03 Fig. 4 pandolfi04 Fig. 5 pandolfi05 Fig. 6 pandolfi06 Fig. 7 pandolfi07 Fig. 8 pandolfi08 Fig. 9 pandolfi09 Fig. 10 pandolfi10 Fig. 11 pandolfi11 Fig. 12 pandolfi12 Fig. 13 pandolfi13 Fig. 14 pandolfi14 Fig. 15 pandolfi15 Fig. 16 pandolfi16 Fig. 17 pandolfi17 Fig. 18 pandolfi18 Fig. 19 pandolfi19 Fig. 20 pandolfi20 Fig. 21 pandolfi21 Fig. 22 pandolfi22 Fig. 23 pandolfi23 Fig. 24 pandolfi24 Fig. 25 pandolfi25 Fig. 26 pandolfi26 Fig. 27 pandolfi27 Fig. 28 pandolfi28 Fig. 29 pandolfi29 Fig. 30 pandolfi30 Fig. 31 pandolfi31 INITIAL SITUATION The patient was a 72-year-old woman who wanted to replace a missing lower right posterior tooth in position #44 that had been extracted many years ago, with a dental implant. The general periodontal state of the patient could be described as moderately compromised. Reported comorbidities included gastritis, gastroesophageal reflux, with easy retching and bruxism, as was apparent by the wear on teeth facets shown in Figs. 2 and 3. TREATMENT PLANNING Clinical examination revealed severe ridge resorption, accompanied by thin soft tissue in the position #44. Intraoral X-ray showed sufficient space between the roots for a 3.3 mm Straumann® BL implant (Fig. 1). However, the ridge was very thin and required horizontal augmentation in order to produce sufficient bone for implant placement (Figs. 2,3). Since she refused to have the bone volume increased by means of a block graft or GBR technique in a two-step approach, she was offered a less invasive protocol with a single surgical step and a minimally invasive flap, GBR and use of mucoderm® for horizontal tissue augmentation. SURGERY The entire surgical procedure was performed under local anesthesia. The paramarginal incision was made to obtain a minimal full thickness mucoperiosteal flap. The drilling was performed with piezosurgery tips combined with a calibrated drill for the insertion of a Straumann® BL ⌀ 3.3mm SLActive® implant according to the manufactures instructions. The traditional non-guided template was used. The surgical site was prepared at a low speed so that autologous bone debris could be collected for the recovered autologous bone technique. The mucoperiosteum was reflected, and the Straumann® BL implant (Roxolid®, SLActive® 3.3mm/14mm) was placed in the 44 site (Figs. 4 — 8). botiss cerabone® mixed with the patient’s autologous bone was used for augmentation of the vestibular bone wall. (Figs. 9,10). The horizontal augmentation of the soft tissue was performed with mucoderm® (Figs. 11,12). Afterwards, a healing cap was fitted, and the site was properly sutured with non-absorbable monofilament suture (Fig. 13). Healing was uneventful, and sutures were removed at one week post-surgery (Figs. 14,15). PROSTHETICS After two months of soft and hard tissue healing (Figs. 16,17), the soft tissue around the implant abutment was healthy, and the buccal contour was maintained (Figs. 18,19). Next, an impression (conventional approach using soft impression material) was taken, and a personalized crown consisting of veneered monocrystalline zirconia on the Straumann® Variobase® abutment was designed using abutment designer software (Figs. 20,21), fabricated and cemented (Figs. 22 — 26). FINAL RESULT After one year (Fig. 27) and two years (Figs. 28 — 31) of follow-up, the clinical situation was stable. No biological or technical complications were reported. Clinical assessment showed a stable position and volumes of both hard and soft tissues. The outcome was a complete reconstruction of the horizontal defect of the tissue. The entire therapy was well planned, the surgical interventions and prosthetic procedures were carefully performed. The final prosthetic result was very satisfactory. The patient was very pleased to have achieved the result with only one-step surgery according to a less invasive protocol. Dr. Andrea Pandolfi Dentist with a private practice in Aprilia (Italy), specialized mainly in Perio-Implantology and Oral Surgery, focusing on minimally invasive procedures. Lecturer, teacher and trainer in Implantology and Biomaterials at universities in Italy and Austria. Member of the ITI (International Team for Implantology) and the SIdP (Società Italiana di Parodontologia e Implantologia). The post Andrea Pandolfi: Reducing invasiveness with a Straumann® Bone Level 3.3 mm narrow-diameter implant and botiss mucoderm® appeared first on STARGET COM.