Straumann Bone Level Tapered Implant · Indication Loading protocol ... simultaneous GBR , healing, gingivoplasty and final ... Straumann® Bone Level Tapered implant drills

Straumann® Bone Level Tapered Implant Peer-to-peer communication

Clinical cases

April, 2015

Case

No.

Site Implant

placement

Loading

Protocol

Author

1 Single unit;

Anterior

Maxilla

Immediate Immediate Dr Arndt Happe,

Germany

2 Multi-unit;

Anterior

Maxilla

Immediate Immediate Dr Sepehr

Zarrine, France

2

Clinical Cases

More clinical cases will be added when available

3 Image(s) courtesy of Dr Bernd Happe, Germany

Dr Arndt Happe,

Priv.-Doz.

Dr. med dent

Oral surgeon

Münster ,Germany

Clinical Case 1 - Introduction

Indication Loading protocol

immediate delayed

Imp

lan

t

pla

cem

en

t immediate maxilla

anterior

1 implant

delayed

Graduated from the University of Münster,

Germany’s post-graduate program in Oral

Surgery, and served as a resident at Prof. F.

Khoury`s Clinic. Owned his own private

practice in Münster since 2000. Holds special

degrees for Implantology and Periodontology

from the corresponding German

Associations. Achieved his postdoctoral

lecture qualification and has been Assistant

Professor at the University of Cologne (Prof.

J.E. Zöller) since 2013.

4

The patient, a 30 year-old female, in good general systemic health, had

experienced unsuccessful endodontic treatment and a failed restoration

of tooth 22. The remaining root is insufficient for retention of a crown

and shows periapical complications

The patient wished for replacement of this tooth with an implant for an

esthetically pleasing restoration

Treatment schedule

Tooth Extraction

Provisional

Restoration

Final

Restoration

Implant

Placement

August 2014

Fractured

tooth 22

December 2014


Pre-operative situation showing the left lateral incisor in the maxilla

The patient has a high lip line when smiling, showing both the papillae

and the gingival soft tissue

There is lost of height of the mesial papilla of tooth 22 when compared

to the contralateral site

Extra-oral


Intra oral situation before surgery

Periapical x-ray shows an

unrestorable root of tooth 22

Pre-operative X-ray


Transmucosal approach showing preparation of the bony cavity without

raising a flap

Implant placement


Lab-fabricated stent which also serves as a provisional restoration

Provisional restoration


Immediate post-operative situation

A retrievable, screw retained provisional restoration is used

The buccal mucosa has been augmented with a CTG (connective tissue

graft) that was inserted into a pouch

Donor site on the palate for the CTG (connective tissue graft) is visible



Post- operative site 12 days after implant

placement

Periapical x-ray with provisional immediate

restoration in-situ



Final restoration

Wax-up of the final crown

Final screw retained restoration

Veneered zirconia cemented on a

titanium base – Straumann

Variobase® Abutment


3 months post-operative situation

Monocrystalline zirconia is used without applying pressure to the soft

tissue, thus creating a favorable emergence profile coronally

Final restoration


4 months after immediate implant

placement and final restoration

Final periapical radiographic appearance

showing healthy tissue integration

Post-operative X-ray


Patient is satisfied with both her extra-oral and intra-oral appearance

after treatment.

Final result


Testimonial from the surgeon


Tips & Tricks from the surgeon

17 Image(s) courtesy of Dr Sepehr Zarrine, France

Dr Sepehr Zarrine

DDS, Dr. med dent

Oral surgeon

Saint Dié

France

Clinical Case 2 - Introduction

Indication Loading protocol

immediate delayed

Imp

lan

t

pla

cem

en

t immediate maxilla

anterior

2 implants

delayed

Exclusive private implantology

practice

Speaker ITI France

European Master in Dental

Implantology, Surgery, Prosthetics,

Bone grafts (Frankfurt, Germany)

University diploma in surgical

maxillofacial rehabilitation (Medicine,

Paris VII)

18

The patient is a 56 year-old, active and healthy man. He does not

smoke, takes no medications and has no allergies. He had a

loose anterior bridge from 11 to 22.

Since his profession requires speaking in public, the appearance

of his anterior teeth has a strong impact on his self-confidence.

Treatment schedule

Tooth Extraction

Provisional

Restoration

Final

Restoration

Implant

Placement

December 2014

Fractured tooth

11 and 22


Slightly inflamed gum with no abscess

Clinical examination revealed vestibular bone loss at tooth 11 and

a decayed root, but no bone loss at tooth 22.

Intra-oral

20

Two treatment options were considered:

1.Extraction, period of healing, re-entry for implantation and

simultaneous GBR , healing, gingivoplasty and final

2. Immediate extraction and implantation with simultaneous GBR

and provisional crown restoration.

The 2nd option was chosen to provide the shortest overall

treatment time.

Planning


Benex® is a registered trademark by BENEX, Luzern/Switzerland.

Removal of the bridge showed a vertical radicular fracture in

tooth 11 and extensive decay in tooth 22

Tooth 22 was extracted atraumatically (using Benex® Extraction

system) and 11 with a very fine elevator

A gingival flap was elevated for access to the bone defect at tooth

11

Implant placement 1


At tooth 11, a flap was elevated for access to augment the buccal

aspect of the alveolar ridge

Buccal bone at tooth 22 was intact so the gingivae was left intact

A surgical guide was used to identify the ideal axes for the

implants and the best emergence level.

Implant placement 2


Two Roxolid® Bone Level Tapered Implants (Ø 4.1mm RC,

SLActive® 14mm) were placed with insertion torques greater than

50Ncm

Both implants were placed more palatally, leaving gaps between

the implant and buccal bony walls

Anchorage was achieved apically, hence the choice of length and

underpreparation of the socket.

Implant placement 3


Autologous bone fragments were collected to fill the deficient

sockets at sites 11 and 22.

At site 11, an osteogingival graft from the maxillary tuberosity was

harvested and fixed with an osteosynthesis screw engaging the

cortical bone of the palate.

Straight Straumann Screw-retained Abutments ( SRA, height

2.5mm ) were placed onto the implants, before flap closure with

5.0 monofilament

Implant placement 4


Abutment level impression for fabrication of the provisional

prosthesis

Protective caps temporarily covered the SRAs during labwork.



6 hours post-surgery

Protective caps were removed without any anesthesia and

temporary bridgework was screwed onto the SRAs

Provisional Restoration


Radiographic examination performed post-surgically with

temporary restoration in-situ

Post-operative X-ray - immediate

28

Post-operative results – 1 week

Successful initial healing phase after 1 week ( these image )

Healthy looking gingiva and the patient reported no symptoms

Image(s) courtesy of Dr Sepehr Zarrine, France

29

Post-operative results – 2 months

Follow-up consultation after 2 months also revealed good healing

results of implant with bone and gingivae.

Image(s) courtesy of Dr Sepehr Zarrine, France

The restoration was successful due to several state-of-the-art

technologies and techniques:

The design of the Straumann® Bone Level Tapered Implants

provided good primary stability in compromised recipient bone

conditions.

The retrieval and reuse of bone fragments using the

Straumann ® Bone Level Tapered implant drills.

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 was completed and the graft has been

consolidated, the final bridge can be planned. 30

Testimonial from the surgeon

International Headquarters

Institut Straumann AG

Peter Merian-Weg 12

CH-4002 Basel, Switzerland

Phone +41(0)61 965 11 11

Fax +41(0)61 965 10 01

www.straumann.com

Documents

Straumann Bone Level Tapered Implant · Indication Loading protocol ... simultaneous GBR , healing, gingivoplasty and final ... Straumann® Bone Level Tapered implant drills