DTUK2010

15Implant TribuneAugust 2-8, 2010United Kingdom Edition I n our clinics, we often have to deal with patients who require a single implant to replace a failing tooth. Our aim should always be aesthetically driven, in that we should always strive to achieve the most stable aesthetic outcome. In the aesthetic anterior zone, we are often faced with an aes- thetic challenge. Do we extract a tooth and delay the placement of an implant allowing the site to heal before implant placement and try to rebuild any bone and soft tissue loss following the heal- ing process? Gingival support The main reason for placing an implant at the same time as ex- tracting the tooth and possibly placing a provisional restoration is to support and maintain the gingival architecture of the fail- ing tooth. In order for us to place im- plants in immediate extraction sites, certain protocols have to be followed to achieve a successful outcome: • Careful patient assessment should be undertaken both clini- cally and radiographically • No active underlying pathology • Gingival form: look at the whether the form is flat or scal- loped and determine the mar- ginal position relative the adja- cent teeth. This is significant in deciding the degree of marginal discrepancy that may occur • Gingival biotype: is the bio- type thick or thin? We can often determine the biotype by prob- ing the buccal tissue and seeing how much of the probe is visible through the tissue. The thinner the tissue, the higher the chanc- es of soft-tissue recession. Carrying out extraction The tooth has to be extracted carefully using peritomes in or- der to avoid unnecessary trauma to the bone. The socket is then cleaned thoroughly and probed to determine the length of the socket from the soft tissue or bone margin. The ideal option would be to place an implant just a few millimetres longer than the socket to engage in the apical bone to achieve primary stabil- ity. Pressure should be avoided on adjacent interdental bone to maintain the papillae between the implant and tooth. For incisal teeth, the mid- palatal socket is an ideal loca- tion for the initial twist drill. The final implant should therefore be placed in more palatal position. The remaining gap be- tween the implant and the buccal plate, if it is less than 1mm, can be filled in with bone. If, how- ever, the gap is larger, bone mate- rial should be used to prevent the collapse of the buccal bone and soft tissue. The ideal depth of the im- plant in the majority of cases is three mm below the soft-tissue margin to ensure the biologi- cal width is not encroached. In areas where there is a bony wall defect, implants can still be placed at the same time as extrac- tion and guided bone regenera- tion can also be carried out the same time. In V-shaped defects, there is often minimal recession compared to U-shaped defects. Placing an immediate provi- sional without encroaching on the tissue with a negative con- tour will help to support the tis- sues. Although immediate im- plant placements can result in a successful outcome, there is slightly higher risk of failure. Thorough examination and surgical execution are vital to en- sure success. DT Aesthetic challenge Thorough examination and execution of treat- ment are key to carrying out immediate tooth replacement Dr Riz Syed explains About the author Dr Riz Syed qualified at the Roy- al London Hospital in 1999 and runs referral clinics in Is- lington and Walton- on-Thames. Regularly consulted for complex treatment planning cases, Dr Syed lectures interna- tionally. To contact Dr Syed, visit www.leadingdentalimplants.com. ©NobelBiocareServicesAG,2010.Allrightsreserved.NobelBiocare,theNobelBiocarelogotypeandallothertrademarksare,ifnothingelseisstatedorisevidentfromthecontextinacertaincase,trademarksofNobelBiocare. All-on-4 was developed to provide clinicians with an efficient and effective restoration using only four implants to support an immediately loaded full-arch prosthesis.* Final solutions include both fixed and removable prostheses such as NobelProcera Implant Bridge Titanium or Implant Bar Overdenture. The tilted posterior implants help avoid relevant anatomical structures, can be anchored in better quality anterior bone and offer maximum support of the prosthesis by reducing cantilevers. They also help eliminate the need for bone grafting by increasing bone-to-implant contact. All-on-4 can be planned and performed using the NobelGuide treatment concept, ensuring accurate diagnostics, planning and implant placement. Nobel Biocare is the world leader in innovative and evidence-based dental solutions. For more information, call + 44 (0) 1895 430650 (UK), 1800 677306 (Ireland) or visit our website. www.nobelbiocare.com Nobel Biocare UK LTD, Telephone: + 44 (0) 1895 430650. Fax: + 44 (0) 1895 430636 Ireland, Telephone: 1800 677306. Fax: 1800 677307 * If one-stage surgery with immediate loading is not indicated, cover screws are used for submerged healing. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. All-on-4™ The efficient treatment concept with immediate loading. Reduced need for vertical bone augmentation. Maximum bone-to-implant contact and preservation of vital structures. High stability with only four implants. Wide variety of prosthetic options with maximum function and fit. NB All-on-four A4 UK.indd 1 10-05-05 15.25.54

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