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Dirk Nolte: Esthetic restoration with Straumann® PURE Ceramic Implants

  The restoration with zirconia implants is discussed due to improved material properties such as low plaque affinity and good biocompatibility as an alternative to titanium implants. This case report describes an esthetically appealing restoration in the premolar region of a young man. Despite slight bone and soft tissue resorption, implantation without complicated bone augmentation was possible. In patients with thin mucosa biotype in particular, the use of zirconia implants should be considered due to the tooth-colored esthetic. PRODUCT INFORMATION BY THE MANUFACTURER The Straumann® PURE Ceramic Implant is the result of more than 9 years of research and development. It has a natural looking ivory color, a feature that makes the implant look more like a natural tooth and 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. According to a survey (data on file at Straumann), patients would prefer tooth-colored implants, if given the choice between ceramic and metal implants. With the Straumann® PURE Ceramic Implant, clinicians can offer their patients a natural and highly esthetic solution, benefitting from favorable soft tissue attachment around zirconia implants. MORE? All about the STRAUMANN® PURE CERAMIC IMPLANT on STARGET at a glance. Click here PICTURE DOCUMENTATION Fig. 1 Initial clinical situation: Interdental spaces in regions 14 and 44. Fig. 2 Initial radiological findings. Fig. 3 Exposure of the crestal bone following incision and detachment of a mucoperiosteal flap using the raspatory. Fig. 4 Preparation of the alveolar ridge using the round bur. Fig. 5 Expansion of the implant bed using twist drills. Fig. 6 Use of the profile drill to reduce the cortical crestal pressure during implant placement. Fig. 7 Placement of the Straumann ® PURE Ceramic Implant. Fig. 8 The margin of the ZLA® surface is epicrestal. Fig. 9 Closure of the implant abutments using back-and-forth sutures with Vicryl 4-0. Fig. 10 Postoperative radiographic follow-up. Fig. 11 Use of the protective splint. Fig. 12 Three months following implantation: irritation-free peri-implant gingival conditions in all regions with nearly excessive soft tissue growth. Fig. 13 Prosthetic tooth on the master cast. Fig. 14 One of the esthetically appealing long-term temporary restorations in situ. Fig. 15 Final situation with irritation-free mucosal conditions in all regions. Fig. 16 Final situation with irritation-free mucosal conditions in all regions. INITIAL SITUATION/CLINICAL FINDINGS Initial situation. An 18-year-old patient was seen at our joint practice following completion of orthodontic treatment. For reasons of symmetry, the space was closed at premolar width with agenesis in regions 15, 14, 24, 25, 35 and 45. In region 46, tooth 46 was extracted at the age 15 years due to a deep cavity and the space closed orthodontically to premolar width. In the third quadrant, the interdental space in region 35 was closed due to mesialization of tooth 36. Following completion of orthodontic treatment with interdental spaces in regions 14, 24 and 44 and a desire for implantological treatment, the patient was seen at our practice (Fig. 1). The patient rejected alternative prosthetic treatment options including fixed one- or two-arm ceramic bridges. The patient had no relevant systemic diseases. Clinical findings. The oral hygiene of the patient at the time of initial presentation could be improved. Clinically, there was bone and soft tissue resorption in regions 14, 24 and 44 in both the vertical and horizontal dimension as observed in the agenesis with no prior orthodontic space closure. In regions 14 and 24, there was sufficient vertical bone due to anatomically distal displacement of the recess of the maxillary sinus. In preoperative planning, a vertical bone height of 18.6 mm was measured in region 44 up to the inferior alveolar canal, which was more than sufficient (Fig. 2). Based on the present clinical conditions and the young age of the patient, we decided for placement of ceramic implants. PROCEDURE The surgery was performed under local anesthesia with vestibular infiltration anesthesia of articaine with epinephrine of 1:200,000 (Ultracain® D-S, Sanofi Aventis) in regions 14, 24 and 44, as well as conduction anesthesia of the N. palatinus major, bilateral and N. mentalis, right. The crestal bone was exposed using the raspatory by means of a slightly lingual or palatal incision and detachment of a mucoperiosteal flap (Fig. 3). The minimum distance of the implant shoulder to the adjacent tooth of 1.5 mm and guidelines for orofacial implant position were maintained. The bone was prepared following strict surgical implantation protocol. The alveolar ridge in an ideal position to obtain a flat surface was prepared in all regions using the round burr with a diameter of 2.3 mm at 800 rpm (Fig. 4). The implant bed (first, pilot drill Ø 2.2 mm at 800 rpm, then pilot drill Ø 2.8 mm at 600 rpm) was prepared in regions 14 and 24 to 12 mm and in regions 44 to 10 mm with adequate water cooling. Twist drills were then used to expand the implant bed at constant aspect ratios to 2.8 mm and 3.5 mm at 500 rpm (Fig. 5). The profile burr was used in regions 14 and 44 to reduce the cortical crestal pressure during implant placement (Fig. 6). With bone class 1 in regions 14 and 44, the standard tap was used at 15 rpm. In region 24, tap preparation was unnecessary with bone class 2 – 3. Following preparation of the implant bed, a Straumann®  PURE Ceramic Implant (Monotype) Ø 4.1 mm with an abutment height (AH) of 5.5 mm and a length (L) of 12 mm was placed in region 14 at 15 rpm, a Straumann® PURE Ceramic Implant Ø 4.1 mm AH 4 mm L 12 mm was placed in region 24 and a Straumann®  PURE Ceramic Implant Ø 4.1 mm AH 5.5 mm was placed in region 44 (Fig. 7). The coronal-apical implant positions were chosen, so that the margin of the ZLA®  surface is epicrestal (Fig. 8). The implant abutments were then closed using back-and-forth sutures with Vicryl 4-0 and an OPTG was taken for postoperative radiographic follow-up (Fig. 9 and 10). A mouthguard was used to protect the implants (Fig. 11). POSTOPERATIVE CARE The patient was prescribed Cefuroxime antibiotic therapy 1-0-1 for five days postoperative. He was instructed in detail after surgery on postoperative oral hygiene measures. The sutures were removed on the seventh day postoperative. The patient was seen for a clinical follow-up three months after implantation. Clinically, there were irritation-free peri-implant gingival conditions in all regions with nearly excessive soft tissue growth (Fig. 12), which can be attributed to the good biocompatibility of zirconia. A situation impression is taken with alginate to fabricate a custom tray. A final impression was taken one week later using Impregum (Impregum™ Penta Soft, 3M ESPE) and the custom tray prepared previously. A master cast was initially fabricated in the laboratory. Long-term temporary restorations were then fabricated in acrylic to optimize the peri-implant soft tissue form. Prosthetic teeth (Pala Mondial, Heraeus Kulzer) with tooth-colored universal acrylic (Palavit 55 VS, Heraeus Kulzer) were fitted on the implant connections (Fig. 13). The esthetically appealing long-term temporary restorations were fixed using zinc-oxide eugenol cement (Temp Bond, Kerr Dental Products) (Fig. 14). The patient was seen at our practice regularly to achieve an optimal mucosal contour by applying or removing material. Once the ideal marginal gingival conditions were formed, the final restoration was carried out after six months. New impressions were taken (Impregum™ Penta Soft, 3M ESPE) to optimally replicate the peri-implant gingival situation. 0.6 mm copings were then fabricated in the laboratory using lithium disilicate glass ceramic (IPS e. max Press LT, Ivoclar Vivadent). The final crowns were modelled on the copings using highly esthetic layering ceramic (IPS e. max Ceram, Ivoclar Vivadent). On subsequent follow-up, mucosal conditions were irritation-free in all regions. Following removal of the long-term temporary restorations, cleaning the abutments and examination of the proximal and occlusal contacts, the ceramic crowns with glass ionomer cement were used (Ketac™ Cem, 3M ESPE) (Fig. 15 and 16). Materials used Straumann® PURE Ceramic Implant, Ultracain D-S 1:200.000 (Sanofi-Aventis, Frankfurt), Impregum™ Penta Soft (3M ESPE, Seefeld), Pala Mon dial (Heraeus Kulzer, Hanau), Palavit 55 VS (Heraeus Kulzer, Hanau), Temp Bond (Kerr Dental Products, Rastatt), IPS e. max Press LT (Ivoclar Vivadent, Ellwangen), IPS e. max Ceram (Ivoclar Vivadent, Ellwangen), Glass ionomer cement – Ketac™ Cem (3M ESPE, Seefeld) Prof. Dr. Dr. Dirk Nolte MKG Praxisklinik Prof. Dr. Dr. Dirk Nolte, Dr. Dr. Robert Linsenmann Sauerbruchstraße 48 81377 Munich Tel. 0 89 / 74 80 99 99 dirk.nolte@mkg-muc.com www.mkg-muc.com 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 Dirk Nolte: Esthetic restoration with Straumann® PURE Ceramic Implants 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.

Sven-Olaf Börner: Environmental dentistry – what is the role of ceramic implants?

  “Environmental dentistry is a new interdisciplinary field encompassing dentists, other medical specialists and dental technicians. The focus of environmental dentistry is on the holistic dental treatment of chronically ill patients, as well as the application of individual preventive treatment concepts with the aim of preventing or relieving chronic inflammatory diseases, including those not related to the oral cavity.” (Definition according to the German Society of Environmental Dentistry, www.deguz.de) Dr. Börner, how did you become involved in environmental dentistry? I came to holistic environmental dentistry through caring for risk patients. I am a classically trained oral surgeon, and my work in our practice focuses on oral surgery and environmental dentistry. Through daily treatment of risk patients, i.e. patients with chronic inflammatory diseases, multisystem disorders, allergies, diabetes, autoimmune diseases, cancer and cardiovascular diseases, as well as of periodontitis patients, I developed an awareness of general medical issues and immunological associations. And this, ultimately, is exactly what environmental dentistry is about: recognizing the interplay between the mouth and the organs, and correctly interpreting the pathological influences of the oral cavity on the immune system. The aim is to find out what most commonly triggers immunosuppressed patients, and this can only work if we study them in detail. An accurate medical history and extensive information are extremely important in this regard. How do patients find about your practice? Normally on referral by their GP or dentist. Also, of course, through recommendations by patients – classic word-of-mouth advertising. As a result, we also have many patients who come to us from other regions. Do patients these days come to you already informed about implants? Yes, but not necessarily in terms of the implant materials available. There are patients who would like a prosthetic but refuse to have any metal in their mouth. This is becoming increasingly common. What is an “environmental dentistry patient”? Basically, every patient is an environmental dentistry patient! The next step, however, is to make a distinction and ask: to what extent is the patient predisposed to develop an immunologically relevant reaction? This ability to distinguish – this is key in how we treat our patients. Can you explain more about this ability to differentiate? We have lots of patients suffering from inflammatory diseases and in need of intensive periodontal and prophylactic care. In addition to this – and this is an extremely important part and ultimately also a reason for our ongoing development in practice – I also receive highly concrete patient referrals from general practitioners. These patients are suffering from cancer, multisystem disorders, chronic infectious diseases or severe allergies. “The patient is first examined on the basis of conventional medicine. The next step, however, is to look for any hidden immunological triggers that may not seem obvious at first glance, for example.” These are, therfore, patients with autoimmune diseases or immunosuppression who come to me from the beginning with the question of whether incompatible materials or confounding factors in the oral cavity could be the trigger for their chronic inflammatory diseases, or any treatment failures. In such patients with a long history of illness, I carry out a very different diagnostic procedure than in a healthy patient who comes to me for the purpose of prevention and check-up. In some ways, for me environmental dentistry is a further development of oral surgery. The patient is first examined on the basis of conventional medicine for inflammation in the mouth and jaw area in an oral surgical approach. The next step, however, is to look for any hidden immunological triggers that may not seem obvious at first glance, for example. The materials used in the oral cavity are studied, any existing endodontic therapy is critically assessed and the results are viewed in the context of the patient’s specific medical history. What could possibly be associated with this or that clinical picture? If an association is identified, a blood test is carried out. In addition, it is also determined whether the patient has craniomandibular dysfunction, which affects the jaw and the skeletal apparatus. Dr. Sven-Olaf Börner treating a patient in his practice in Grünwald, Germany. How does such a blood test work? Blood is taken from the patient and analyzed on the basis of the question in hand, and conclusions are drawn as to whether a systemic disease or a disorder is associated with an allergy to or intolerance of a material. Allergy to titanium is extremely rare*, but allergies are not the only cause of immunology-related intolerances. Immunological reactions, i.e. release of the body’s own pro-inflammatory antibodies known as cytokines, are becoming increasingly common. MORE? All about the STRAUMANN® PURE CERAMIC IMPLANT on STARGET at a glance. Click here What is measured in these tests? The release of cytokines can be ­qualitatively­ and quantitatively measured. This is not the only criterion, however – ultimately the key lies in genetic interleukin polymorphism, which we also identify in parodontology and in connection with peri-implantitis, and in the release of the proinflammatory cytokines IL1-ß and TNF-a in order to establish a link with these through stimulation by titanium dioxide. The intensity with which the immune system reacts to titanium dioxide, for example, is individual and a temporary value. “It can be taken for granted that ceramic implants are biocompatible. In future, higher flexibility in prosthetics and long-term data would be desirable.” In addition to this, every one of us has a specific degree of personal, genetically determined inflammatory reaction. This inflammation level 0 – 4 is thus also jointly responsible for determining the future development of the material’s tolerability and hence for its immunological relevance. If a patient is classified as level 3 or 4, then they are considered to be a “high responder”. This means that in these patients the genotype constellation is accompanied by an increased production of proinflammatory cytokines with a simultaneous reduction in anti-inflammatory receptor antagonists. This group therefore reacts very strongly to a source of inflammation and is at increased risk of implant loss. A completely different approach must therefore be taken to high responders with level 3 or 4 than to level 0 or 1 responders. Are these tests covered by health insurers? The titanium stimulation test aimed at determining cytokine release and the determination of the genetic inflammation level in association with the implant are not subsidized by statutory health insurers. An allowance may be provided for a lymphocyte transformation (allergy) test on materials in the event of a patient with multiple allergies and the corresponding justification. Queries and reimbursement difficulties also tend to be common with private health insurers. For me, therefore, ceramic implants are increasingly becoming a standard instrument. And they save the patient the cost of the test, which is around 180 – 200 euros. Treatment room of Dr. Sven-Olaf Börner’s practice. How long have you been working with ceramic implants? I have been gaining experience with one-piece ceramic implants in my practice for seven years now. It has long been known for longer, however, that ceramic implants are clinically effective. I completed my training in oral surgery in Baden-Württemberg, and at the beginning of the 1990s I gained retrospective experience with Tübingen immediate implants made of aluminum oxide ceramic. Surprisingly, these were often excellently osseointegrated, but unfortunately showed insufficient fracture strength. What do you believe are the most important features of ceramic implants today? Strength, naturally, combined with excellent osseointegrative properties. It can be taken for granted that ceramic implants are biocompatible. In future, higher flexibility in prosthetics and secure long-term data would be desirable. “Then I show the patients the bright, metal-free, one-piece ceramic implant. This inspires positive emotions, creates trust and makes it easier to provide the patient with further information.” What are the benefits of ceramic implants in your opinion? In the event of thin gingiva, a ceramic implant helps to avoid a grey shimmer. This pleases both the patient and the practitioner (laughs). The result is a more attractive, cleaner look. Also, I have observed that patients who perhaps do not maintain optimal oral hygiene clearly experience more extensive plaque accumulation with titanium implants than with ceramic ones. In addition to this, irritation around the implants or secondary parts also appears to be considerably less common with ceramic implants. What type of implant does a typical patient in your practice request? The patients sitting opposite me are saying more and more often: “I do not want an implant, because I do not want any metal in my body”. Then I show the patients the bright, metal-free, one-piece ceramic implant. This inspires positive emotions, creates trust and makes it easier to provide the patient with further information.” Just one more question: What has been your experience with the Straumann® PURE Ceramic Implant (monotype)? I am completely satisfied with the clinical results. Dr. Börner, many thanks for providing a fascinating insight into environmental dentistry and your day-to-day work. * Comment by Dr. Volker von Baehr from the Laboratory for Special Immunology at the Institute of Medical Diagnostics in Berlin-Potsdam, Germany: “Real titanium allergies are rare, however. Unlike other metals, titanium (oxide) cannot function as an ion and modify endogenous proteins. Metal allergies such as those we are familiar with in the context of nickel and cobalt are therefore not possible. The problem occurs when patients have an increased susceptibility to an inflammatory reaction caused by titanium particles. This is caused by polymorphism in the genes of our proinflammatory key cytokines, which affects approximately 15 % of the population in Central Europe. This does not mean that all of these 15 % will experience an increase inflammatory reaction to titanium, but it is a risk factor similar to diabetes and smoking. Naturally, these 15% are also more or less found via genetic tests. Added to this are the approximately 3 – 4 % with abnormal results in the functional test (titanium stimulation test) who do not have a (known) genetic predisposition. This is most likely due to less common genetic constellations in inflammation modulation, which are not found in the standard test. It can therefore be concluded that in immunological terms, this risk constellation is present in almost 20 %.” Sven-Olaf Börner boerner_p Sven-Olaf Börner Dr. med. dent. Oral surgeon. Studied at the Freie Universität Berlin, Germany. Training at an oral and maxillofacial practice. Doctorate at RWTH Aachen University, Germany. In 1998, establishment of own practice near Munich, Germany. Since 2005, network-oriented, holistic care concept. Since 2014, OCplus practice. National and international speaker. www.ocplus.de   CLINICAL REVIEW The clinical facts behind the Straumann® PURE Ceramic Implant. Click here BROCHURE Download the brochure for the Straumann® PURE Ceramic Implant. Click here SUBSCRIBE Subscribe to our monthly STARGET newsletter to receive the latest news about implant dentistry. Click here The post Sven-Olaf Börner: Environmental dentistry – what is the role of ceramic implants? appeared first on STARGET COM.

Sepehr Zarrine: The BLT’s contribution to ­primary ­stability and osseointegration in ­damaged esthetic areas (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. [Manufacturer’s product information] PICTURE DOCUMENTATION Fig. 1 zarrine01 Fig. 2 zarrine02 Fig. 3 zarrine03 Fig. 4 zarrine04 Fig. 5 zarrine05 Fig. 6 zarrine06 Fig. 7 zarrine07 Fig. 8 zarrine08 Fig. 9 zarrine09 Fig. 10 zarrine10 Fig. 11 zarrine11 Fig. 12 zarrine12 Fig. 13 zarrine13 Fig. 14 zarrine14 Fig. 15 zarrine15 Fig. 16 zarrine16 Fig. 17 zarrine17 Fig. 18 zarrine18 Fig. 19 zarrine19 Fig. 20 zarrine20 INITIAL SITUATION The patient is a 56-year-old, active and healthy man. He does not smoke, does not take any medications and has no allergies. He was referred to us, presenting a loose anterior bridge from 11 to 22 (FDI). Since his profession requires speaking in the public, his clinical situation in the esthetic zone has a negative impact on his self-confidence. The clinical examination (Figs. 1, 2) revealed a slightly inflamed gum with no abscess. Clinical probing indicated that there was vestibular bone loss at tooth 11 and a decayed root, but no bone loss at tooth 22. TREATMENT PLAN Two treatment options were considered: Extraction of both roots, healing, re-entry to place two non-submerged implants with simultaneous GBR, healing, gingivoplasty and placement of the final prosthesis. Extraction of both roots, immediate implantation with simultaneous bone reconstruction and gingival reinforcement, dental crown placement on the same day, i.e. immediate placement and immediate provisionalization. In order to restore the patient with a reduced overall treatment time (including the time needed for surgery), we opted for the second solution. We have adapted an osteogingival tissue graft technique that has been employed for several years with excellent results. Pre-surgical assessment indicated potential primary stability issues at the site of tooth 11, where only a few millimeters of bone remained for implant anchorage. Therefore, we used the Straumann® Bone Level Tapered Implant, designed to achieve good primary stability even in clinical indications where this would be difficult to achieve. Furthermore, the Straumann® SLActive® surface is known to provide fast osseointegration. Pre-surgical impressions were taken in order to prepare a surgical guide and a perforated impression tray. SURGICAL PROCEDURE Once the bridge was removed, a vertical radicular fracture was confirmed in tooth 11 and an extensive decay in tooth 22. Atraumatic root extractions were performed, on tooth 22 by applying the Benex® Extraction System (Fig. 3) and on 11 with a very fine elevator (Fig. 4). A gingival flap was elevated to access the bone defect at tooth 11 (Fig. 5).  Since the buccal side at tooth 22 was still intact, the gingiva was also left attached to the bone (i.e. flapless procedure) in order not to disturb the periostium attachment to the bone. At tooth 21, a flap was rolled to thicken the buccal alveolar ridge aspect. The two tooth sockets were meticulously scraped and cleaned with a round bur. The surgical guide helped identify the ideal axis for the implant as well as the best emergence level (Figs. 6, 7). Once the landmarks were identified, the drilling was performed and then the guide was repositioned to verify the axis of the alignment pins (Fig. 8). To achieve a sufficient primary stability, the BLT drill with a diameter of 2.8 mm was used as the final preparation step. The insertion torque for both Roxolid® Bone Level Tapered Implant, ∅ 4.1 mm RC, SLActive® 14 mm was greater than 50 N/cm*. The implant at site 22 was placed towards the palate to maintain a narrow buccal gap between the implant and the socket wall. The implant at site 11 had 8 visible threads after insertion. It was also inserted towards the lingual aspect of the extraction socket such as that a gap remained between the implant and the buccal bone wall (Fig. 9). The anchoring for both implants was achieved with the last apical millimeters, which is why the 14 mm length and underpreparation were necessary. The majority of the drilled bone fragments were recovered thanks to the design of the BLT drills and a portion of this bone was used to fill the gap around the implant on position 22. The remaining material was used to cover the surface of the implant. To simultaneously regenerate the bone deficit and reinforce the gingiva, we used a special technique that we have been optimized during several years. We took an osteogingival graft form the maxillary tuberosity of the wisdom tooth. A prior 3D examination had confirmed that the maxillary tuberosity presented good volume. This combined graft for osseointegration was de-epithelialized (Fig. 10) and then impacted into the vestibular gap of the central incisor. To prevent any mobility, an osteosynthesis screw fixed the bone core on the residual alveolar ridge by engaging the cortical bone of the palate (Fig. 11).  Straight Straumann® Screw-retained Abutments (SRA) with a height of 2.5 mm were placed on the implants. Suturing was performed using resorbable 5.0 monofilament. Then, abutment-level open tray impression posts were screwed on and a sectoral impression was taken using the perforated impression tray (Fig. 12). Once the impression was taken, two protective caps were placed to prevent the gingiva from covering the SRAs during the day. The prosthetic planning process was performed with the dental laboratory, which will also perform the final work. Six hours after surgery the gingiva was stable enough (Fig. 13) to remove the protective caps without anesthesia and the temporary bridge was screwed onto the SRAs (Figs. 14 – 17). Visual and radiological examinations were performed one week post-surgery (Figs. 18, 19) which demonstrated that the initial healing phase was successful. The gingiva looked healthy and the patient was without clinical complications. At a re-entry after two months clinical observation determined that the implants, bone and gingiva had healed perfectly (Fig. 20). CONCLUSION This challenging case demonstrates the possibility to compress a multi-step clinical procedure into a manageable and cost efficient time-frame. Furthermore, given this implant’s location in the esthetic zone, the technique could be of particular interest to both clinicians and patients alike. The restoration was successful due to the combination of several state-of-the-art technologies and techniques: (1) the use of Straumann® Bone Level Tapered Implants, which, thanks to their ­design and flexible drilling protocol, allow for good primary stability in ­compromised recipient bone conditions, (2) the retrieval and reuse of bone fragments using the Straumann® Bone Level ­Tapered implant drills (3) the use of the maxillary tuberosity osteogingival tissue graft technique. With this, we were able to provide our patient fixed teeth in a single day. The temporary bridge had no occlusal contact and only served to enable the patient to speak and smile. Once osseointegration is completed and the graft has been consolidated, the final bridge can be planned. Thanks to Pierre Chapuis and his team at Laboratoire Oral Beauty (Bruyeres, France): oralbeauty.com * It is recommended to place the implant with an insertion torque of 35 Ncm. See NAMLIT1043 Availability and regulatory status of products described in this article in your country: please contact your local official Straumann representative for further information. Sepehr Zarrine, France DDS Sepehr Zarrine, France DDS Oral surgeon. Exclusive private implantology practice (Saint Dié, France). Speaker ITI France. European Master in Dental Implantology. Surgery, prosthetics, bone grafts (Frankfurt, Germany). University diploma in surgical maxillofacial rehabilitation (Medicine, Paris VII). dr.zarrine@gmail.com surgitechstudies.com The post Sepehr Zarrine: The BLT’s contribution to ­primary ­stability and osseointegration in ­damaged esthetic areas (Straumann® Bone Level Tapered Implant) appeared first on STARGET COM.

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