The Single-tooth Implant Treatment of Mandibular First Molar Using Individual Abutments: Ⱥ Case Report Abstract Case Report Introduction

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1 The Single-tooth Implant Treatment of Mandibular First Molar Using Individual Abutments: Case Report Marin Petrosyan, BeniaminVardanyan YSMU, Department of Prosthodontics Keywords: Dental Implants, Individual Abutment, Mandibular Molar Abstract The mandibular first molar is the most common absent tooth. There are several treatment options for replacing the missing first molar, including toothsupported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing first molar teeth when the skeletal development is complete. This case report presents the treatment of a patient with a missing mandibular first molar with an individual abutment. Introduction The tooth loss in the posterior region is commonly the result of caries, non-carious damage or a trauma. Several options are available for the replacement of a missing tooth. These include removable dental prostheses, conventional fixed dental prostheses (FPDs), resin-bonded FPDs, orthodontic repositioning of second molars to close the edentulous space, and a single-tooth implant. The removable dental prosthesis is often used as a transitional restoration for a mandibular first molar tooth. The traditional treatment for an edentulous space in mandibular first molar area is a conventional three-unit or cantilever FPD. While some clinicians may suggest that a resin-bonded prosthesis is available option, clinical experience has shown that these resin-bonded pontics do not have a good long-term success rate if the teeth are not prepared aggressively enough for mechanical retention. Debonding rates of 25%-31% have been reported for these restorations 1. The dental implant is an appropriate treatment option for replacing a missing tooth. Dental implants can be placed as soon as the edentulous space has been created and the tissues have been stabilized after extraction or orthodontic treatment. The cervical esthetics of a single implant crown must accommodate a round diameter implant and balance hygiene and esthetic parameters. In the posterior area, the placement of an implant in a prosthetically ideal position is often not possible because of the lack of sufficient bone vertically or horizontally. Because of esthetic or hygiene needs, individual abutments are often needed after placement of dental implants in the posterior zone. The preservation of soft tissues and regeneration of interdental papillae are critical for the esthetic success of single-implant-supported crowns 2, 3. Provisional restorations are an important stage before final restoration allowing guided soft tissue management and creating a functional and esthetic emergence profile. This case report presents the single-tooth implant treatment of a patient with missing mandibular first molar using individual abutments. The aim of this report was to evaluate and discuss the clinical use of individual abutments. Case Report A 28-year-old female patient with pain referred to the Department of Prosthodontics, YSMU. Her medical and dental history was evaluated. Dental history revealed that she had a retreated tooth. Periapical and panoramic radiographs and preliminary impression were taken for a diagnostic evaluation. X-Ray revealed a perforation of the canal and periapical lesion. A decision was made for tooth extraction and dental implant treatment. The 36 th tooth was extracted. Surgical procedures were done 4 months later. A surgical stent was prepared for the correct implant position. The formal surgical procedure recommended by the manufacturer of the dental implant system (Alpha-bio Israel) was followed. 4.2*10mm implant was selected and placed. The implant shoulder was placed to the 2 mm apical part of the cement-enamel junction of the neighboring teeth, with the aid of surgical stent. During the healing period, the patient was wearing an acrylic provisional removable dental prosthesis relieved in the implantation sides. After three months, at the second stage surgery, the cover screw was removed, and gingiva former was located. 69

2 Gingival formers were unscrewed and preliminary impression of the mandibular arch was made using vinyl polysiloxane impression material (Bisico Germany) while the transfer coping was in place. The implant analog was secured in its place in the impression and the cast was poured in type IV hard plaster. Plastic abutment selection was performed in the patient s mouth and on the cast. Plastic abutment was prepared due to the lingualposition problem of the implant. Temporary crown was made on the cast using temporary restoration material (fig.2, 3). A screw- retained temporary crown was attached to the implant screwed onto them and tightened to 25 Nm using ratchet and ratchet hex driver (fig4). This period is meant to provide a desirable shape of the gingiva. The patient was informed on oral hygiene and instructed about the specific care for her new restoration including the tooth brushing and flossing. Figure 4. screwing a temporary crown on implant by ratchet Figure 1. sulcusformer is located The temporary crown was screwed (fig.5). Follow ups were done twice a month and soft tissue contours were received after two months (fig.6). Predictable soft tissue profiles were achieved with a simplified implant prosthetic protocol. An impression procedure that reproduces the intraoral relationship of implants is the first step in achieving an accurately fitting prosthesis. Two commonly used implant impression techniques are the closed tray and the open tray techniques. The open tray technique is used. Figure5 screwed temporary crown Figure 2. prepared temporary crown occlusalview.figure3.prepared temporary crown axial view Temporary crown was screwed on implant for two months aiding also for making the tissue form. Cartable plastic abutments were the only realistic alternative for achieving aesthetic, anatomic-like implant restorations. Clinical-laboratory procedures were performed permanent crowns were fabricated (fig10, 11, 12, 13). The case presented in this paper was restored successfully with a good patient acceptance. Discussion Long-term studies have shown that the success rate of the osseo-integrated implants reach almost 100% 4, 10. Although, the use of dental implants is well documented in the literature, placing dental 70

3 implants in the posterior mandibular area is considered to be the ultimate challenge for many dentists particularly when adjacent teeth exist. In case of some patients, the space across the alveolar crest is too narrow to allow placement of an implant. Figure10 Figure6 soft tissue form before Figure11 Figure7 predictable soft tissue form Figure12 PFM restoration Figure8 individual transfer Figure13 screwed PFM restoration Figure9 final impression (open tray technic) The root apices of the adjacent premolar are in a close proximity. In other cases, ridge thickness may be inadequate, requiring soft tissue or bone augment-tation. The placement of implants in a correct position is one of the most important 71

4 outcomes 5. Conventional radiography, computed tomography is invaluable methods to evaluate the alveolar bone, three-dimensionally in the placement zone before surgery. Surgical stents are used for proper positionning of the implants during surgery. Surgical guides are fabricated using conventional technique which promotes more precise and exact positioning of the implants during surgery. The quantity and quality of alveolar bone as well as soft tissues around the implant must be assessed carefully before considering implant placement 6. Horizontal and vertical bone deficiencies cause complications. A standard implant in the mandibular posterior area should be minimum of 10mm length and minimum of 3.75 diameter.adequate space for the implant is also required between the adjacent roots.1.5 to 2 mm of space is necessary between the implant and the adjacent roots 7. In cases when there is insufficient alveolar bone for implant placement ridge augmentation may be necessary. In this case sufficient alveolar bone exists and implant with 4.2mm diameter is used. The malposition of the implant shoulder in the coronoapical direction causes soft tissue recession 8. The provisional restoration is recommended to protect the peri-implant tissue and to prevent collapse before final restoration. After screwing the temporary crown the soft tissue recession is expected.individual castable implant abutments are made by gold alloy or titanium. Dental implants can be restored with cemented or screw-retained FPDs. In cases of single-tooth implant treatment screw-retained FPDs are preferable, but in some cases cemented restorations could to be chosen 9. Individual abutments provide tooth-like restoration. This method is acceptable for our region as it s not so expensive and a clinical- laboratory stages are available. Screw-retained FPDs can be removed more easily than adhesive resin cemented crowns. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics. References 1. Hussey DL, Pagni C, Linden GJ. Performance of 400 adhesive bridges fitted in a restorative dentistry department. J Dent. 1991; CAS 2. Albrektsson T, Zarb G, Worthington P et al. The longterm efficacy of currently used dental implants: a review and proposed criteria of success.int J Oral Maxillofac Implants 1986; 1(1): PubMed CAS 3. Lang NP, Berglundh T, Heitz-Mayfield LJ et al. Consensus statements and recommended clinical procedures regarding implant survival and complications. Int J Oral Maxillofac Implants 2004; 19(Suppl): PubMed 4.. Belser UC, Schmid B, Higginbottom F, Buser D. Outcome analysis of implant restorations located in the anterior maxilla: a review of the recent literature. Int J Oral Maxillofac Implants.2004;19(Suppl): [PubMed] 5. Rupp RP, Dillehay JK, Squire CF. Orthodontics, prosthodontics, and periodontics: a multidisciplinary approach. Gen Dent. 1997;45(3): [PubMed] Richardson G, 6. Russell KA. Congenitally missing maxillary lateral incisors and orthodontic treatment considerations for the single-tooth implant. J Can Dent Assoc. 2001;67(1):25 8. [PubMed] 7. Spear FM, Mathews DM, Kokich VG. Interdisciplinary management of single-tooth implants. Semin Orthod. 1997;3(1): [PubMed] 8. Buser D, Belser U, Wismeijer D. 1st ed. Berlin: Quintessence; ITI treatment guide: implant therapy in the esthetic zone for single-tooth replacements. 9. Chee W, Jivraj S. Designing abutments for cement retained implant supported restorations. Br Dent J. 2006;201(9): [PubMed] 10. Henry PJ, Laney WR, Jemt T, Harris D, Krogh PH, Polizzi G, et al. Osseointegrated implants for singletooth replacement: a prospective 5-year multicenter study. Int J Oral Maxillofac Implants.1996;11(4): [PubMed] Figure 14 Panoramic X-Ray after treatment Summary Dental implant treatment of a patient with acquired missing mandibular first molar was performed using standard diameter implant and individual abutment. The implant supported prosthesis is a great choice for replacing a missing tooth and treatment using individual abutments was satisfactory for the patient s esthetic expectations....,..,. - : (, -, )., -, -,

5 , -, -.,.,. :..,.. -, - : -. /, -, - / : -, -, -, : : : - / / : :, - : - -, - : -..,... : ( ).. New Aspects In Clinical Use Of Interactive Self-Ligating Brackets Ter-Poghosyan H.Yu., Ghazaryan E.R. Technical features of use of interactive self-ligating brackets will be presented in this report. New mechanism of interaction, proposed by us, in system: orthodontic archwire; interactive self-ligating bracket; tooth; lip (cheeks) will be described. Comparative analysis of orthodontic treatment duration and number of visits with demonstration of clinical cases will be also presented in this report. -..,.. :,,, ( ) : ` : 73

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