Straumann Bone Level Tapered Implant Peer-to-peer communication

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1 Straumann Bone Level Tapered Implant Peer-to-peer communication Clinical cases April, 2015

2 Clinical Cases Case No. Site 1 Single unit; Anterior Maxilla 2 Multi-unit; Anterior Maxilla Implant placement Loading Protocol Author Immediate Immediate Dr Arndt Happe, Germany Immediate Immediate Dr Sepehr Zarrine, France 2 More clinical cases will be added when available

3 Implant placement Clinical Case 1 - Introduction Dr Arndt Happe, Priv.-Doz. Dr. med dent Oral surgeon Münster,Germany 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 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 Indication immediate delayed Loading protocol immediate delayed maxilla anterior 1 implant 3 Image(s) courtesy of Dr Bernd Happe, Germany

4 Treatment schedule Tooth Extraction Implant Placement Provisional Restoration Final Restoration August 2014 December 2014 Fractured tooth 22 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 4

5 Extra-oral 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 5 Image(s) courtesy of Dr Bernd Happe, Germany

6 Pre-operative X-ray Intra oral situation before surgery Periapical x-ray shows an unrestorable root of tooth 22 6 Image(s) courtesy of Dr Bernd Happe, Germany

7 Implant placement Transmucosal approach showing preparation of the bony cavity without raising a flap 7 Image(s) courtesy of Dr Bernd Happe, Germany

8 Provisional restoration Lab-fabricated stent which also serves as a provisional restoration 8 Image(s) courtesy of Dr Bernd Happe, Germany

9 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 9 Image(s) courtesy of Dr Bernd Happe, Germany

10 Provisional restoration Post- operative site 12 days after implant placement Periapical x-ray with provisional immediate restoration in-situ 10 Image(s) courtesy of Dr Bernd Happe, Germany

11 Final restoration Wax-up of the final crown Final screw retained restoration Veneered zirconia cemented on a titanium base Straumann Variobase Abutment 11 Image(s) courtesy of Dr Bernd Happe, Germany

12 Final restoration 3 months post-operative situation Monocrystalline zirconia is used without applying pressure to the soft tissue, thus creating a favorable emergence profile coronally 12 Image(s) courtesy of Dr Bernd Happe, Germany

13 Post-operative X-ray 4 months after immediate implant placement and final restoration Final periapical radiographic appearance showing healthy tissue integration 13 Image(s) courtesy of Dr Bernd Happe, Germany

14 Final result Patient is satisfied with both her extra-oral and intra-oral appearance after treatment. 14 Image(s) courtesy of Dr Bernd Happe, Germany

15 Testimonial from the surgeon 15 Image(s) courtesy of Dr Bernd Happe, Germany

16 Tips & Tricks from the surgeon 16 Image(s) courtesy of Dr Bernd Happe, Germany

17 Implant placement Clinical Case 2 - Introduction Dr Sepehr Zarrine DDS, Dr. med dent Oral surgeon Saint Dié France 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) Indication immediate delayed Loading protocol immediate delayed maxilla anterior 2 implants 17 Image(s) courtesy of Dr Sepehr Zarrine, France

18 Treatment schedule Tooth Extraction Implant Placement Provisional Restoration Final Restoration Fractured tooth 11 and 22 December 2014 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. 18

19 Intra-oral 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 Image(s) courtesy of Dr Sepehr Zarrine, France

20 Planning 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 2 nd option was chosen to provide the shortest overall treatment time. 20

21 Implant placement 1 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 Image(s) courtesy of Dr Sepehr Zarrine, France Benex is a registered trademark by BENEX, Luzern/Switzerland.

22 Implant placement 2 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. 22 Image(s) courtesy of Dr Sepehr Zarrine, France

23 Implant placement 3 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. 23 Image(s) courtesy of Dr Sepehr Zarrine, France

24 Implant placement 4 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 24 Image(s) courtesy of Dr Sepehr Zarrine, France

25 Provisional restoration Abutment level impression for fabrication of the provisional prosthesis Protective caps temporarily covered the SRAs during labwork. 25 Image(s) courtesy of Dr Sepehr Zarrine, France

26 Provisional Restoration 6 hours post-surgery Protective caps were removed without any anesthesia and temporary bridgework was screwed onto the SRAs 26 Image(s) courtesy of Dr Sepehr Zarrine, France

27 Post-operative X-ray - immediate Radiographic examination performed post-surgically with temporary restoration in-situ 27 Image(s) courtesy of Dr Sepehr Zarrine, France

28 Post-operative results 1 week Successful initial healing phase after 1 week ( these image ) Healthy looking gingiva and the patient reported no symptoms 28 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. 29 Image(s) courtesy of Dr Sepehr Zarrine, France

30 Testimonial from the surgeon 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

31 International Headquarters Institut Straumann AG Peter Merian-Weg 12 CH-4002 Basel, Switzerland Phone +41(0) Fax +41(0)

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