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
5 Image(s) courtesy of Dr Bernd Happe, Germany
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
6 Image(s) courtesy of Dr Bernd Happe, Germany
Intra oral situation before surgery
Periapical x-ray shows an
unrestorable root of tooth 22
Pre-operative X-ray
7 Image(s) courtesy of Dr Bernd Happe, Germany
Transmucosal approach showing preparation of the bony cavity without
raising a flap
Implant placement
8 Image(s) courtesy of Dr Bernd Happe, Germany
Lab-fabricated stent which also serves as a provisional restoration
Provisional restoration
9 Image(s) courtesy of Dr Bernd Happe, Germany
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
Provisional restoration
10 Image(s) courtesy of Dr Bernd Happe, Germany
Post- operative site 12 days after implant
placement
Periapical x-ray with provisional immediate
restoration in-situ
Provisional restoration
11 Image(s) courtesy of Dr Bernd Happe, Germany
Final restoration
Wax-up of the final crown
Final screw retained restoration
Veneered zirconia cemented on a
titanium base – Straumann
Variobase® Abutment
12 Image(s) courtesy of Dr Bernd Happe, Germany
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
13 Image(s) courtesy of Dr Bernd Happe, Germany
4 months after immediate implant
placement and final restoration
Final periapical radiographic appearance
showing healthy tissue integration
Post-operative X-ray
14 Image(s) courtesy of Dr Bernd Happe, Germany
Patient is satisfied with both her extra-oral and intra-oral appearance
after treatment.
Final result
15 Image(s) courtesy of Dr Bernd Happe, Germany
Testimonial from the surgeon
16 Image(s) courtesy of Dr Bernd Happe, Germany
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
19 Image(s) courtesy of Dr Sepehr Zarrine, France
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
21 Image(s) courtesy of Dr Sepehr Zarrine, France
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
22 Image(s) courtesy of Dr Sepehr Zarrine, France
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
23 Image(s) courtesy of Dr Sepehr Zarrine, France
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
24 Image(s) courtesy of Dr Sepehr Zarrine, France
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
25 Image(s) courtesy of Dr Sepehr Zarrine, France
Abutment level impression for fabrication of the provisional
prosthesis
Protective caps temporarily covered the SRAs during labwork.
Provisional restoration
26 Image(s) courtesy of Dr Sepehr Zarrine, France
6 hours post-surgery
Protective caps were removed without any anesthesia and
temporary bridgework was screwed onto the SRAs
Provisional Restoration
27 Image(s) courtesy of Dr Sepehr Zarrine, France
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
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