180 A CLOSER LOOK AT THE CLINICAL DATA

Extraction of mandibular molar with immediate placement

Surgery: Dr. Alejandro Berg

Restoration: Dr Alejandro Berg

5 Sept 2013 – 02 May 2014

Gender: MaleAge: 47

Patient Complaint: “I have pain on my lower right side, my dentist told me I need to extract my wis-dom tooth and so I would like to have implants placed at the same time”

Past Medical History:

■ Patient is Diabetic in treatment with Metformin.

■ Light smoker.

■ No known allergies.

Patient Information

Patient InformationClinical Findings:

■ 46 and 47 are absent, 48 is present and restored with an amalgam(defective). At CBCT 48 presents large apical lesion.

■ Periodontal probing depth at 48 of 6 mm at the furcation area

■ No active fistula

■ Slight horizontal atrophy of ridges in 46 and 47

Radiographic Findings:

Diagnosis

Patient is partially edentulous and needs to have the wisdom tooth and apical lesion removed. There is a cosmetic component due to the lack of 46 that clearly shows when patient speaks and even more when he laughs.

Treatment Plan

■ Extraction of 48

■ Lesion removal 48

■ Socket detoxification with Tetracycline for 4 minutes

■ Bone graft 48 (Easygraft Classic, Sunstar, Japan)

■ PALTOP implant placement 47 and 46 at same surgical time.

■ Connected implants with no provisional

■ Early loading with final restorations.

■ Large apical lesion detected in 48, good length and fair width of ridge in 47 and 46.

■ 48 presents defective large amalgam and decay

Materials and MethodsA cone beam CT scan was taken to visualize the implant site. Complete presence of the buccal plate was confirmed. Ideal positioning of the implant osteotomy was determined.

Presence and dimension of apical lesion was determined

Based on CBCT analysis the sizes of the implants were selected (42x13 for 47 and 42 x 13 for 46)

It was determined that to reduce horizontal and vertical loss after extraction, Sunstar Easygraft Classic was to be used for alveolar preservation, no full closure or flap advancement will be needed, hence no pink esthetic line distortion would be induced.

Case Report 3

PALTOP Advanced Dental Solutions Ltd. 181

SCIENCE DIVISION

A cone beam CT scan was taken to visualize the implant site. Complete presence of the buccal plate was confirmed. Ideal positioning of the implant osteotomy was determined.

Presence and dimension of apical lesion was determined

The surgical site was anesthetized with local anesthesia. 2% Mepivacaine, 3 cartridges in Spix Technique and peri focal.

Extraction and lesion removal of 48 with full septum conservation was achieved.

Flapless approach in 46 and 47 following PALTOP drilling sequence, bone was found to be extremely soft (class 3 or 4) for the area.

Manual insertion was used and implants were torqued into final position with the ratchet.

Manual insertion was used and implants were torqued into final position with the ratchet.

Full sealing with ENA Hri ( Micerium, Italy) and final occlusion was achieved.

Final x-rays at 21 months show perfect conservation and full bone maturation

ResultsFinal time for the case was 8 weeks and then 12 weeks more until final discharge of the patient.

The graft was noticeably integrated in the final X-rays 21 months after installation.

The use of overcasting and ceramic contouring of the gums allowed for seamless integration to the oral environment and for a perfect esthetic result after final seal. Patient describes his experience as very pleasant and now is undergoing another 5 implants for full mouth reconstruction.

21 months later control photo

Final restoration was placed 10 days later, Titanium overcast over Ti base abutments, at 30 Ncm, initial occlusion and temporary access hole were sealed.

3 months later access holes were finally closed after retorque to 40Ncm and using PTFE to isolate the screw.