Dental Tribune United Kingdom Edition

February 14-20, 201120 Implant Tribune United Kingdom Edition A medically and peri- odontally stable 50-year old woman presented with failing #8 and #9 teeth that exhibit asymmetry, lack of interdental papilla and a history of failing root-canal therapy and apicoectomy (Fig 1). Treatment Plan 1. Extraction of teeth #8 and #9, immediate implantation of #8 and #9 and immediate non-functional provisionalisation of #8 and #9 2. Three-month healing period 3. Gingivectomy to create mucos- al symmetry 4. Six-month healing period, dur- ing which contour adjustments to interim restoration will be made to manipulate papillary regeneration 5. Placement of final single PFM crowns on implants #8 and #9 Treatment Plan Rationale Implant rehabilitation for sites #8 and #9 boosts long-term prosthetic success, which dimin- ishes future costs and permits more future restorability options. The patient is an ideal candidate for immediate implant place- ment and temporisation due to her thick biotype, which resists recession, as well as the inher- ent coronal positioning of the gingival drape around #8 and #9 compared to the adjacent teeth, which allows any minor recession post-treatment to re- main within aesthetically-pleas- ing bounds. Extraction of Teeth #8 and #9, Immediate Placement of Implants #8 and #9, and Im- mediate Non-Functional Pro- visionalisation of Implants #8 and #9 After oral sedation with 0.25mg triazolam and local anaesthetic induction using two percent lido- caine with 1:100,000 epinephrine and 0.5 per cent bupivacaine with 1:200,000 epinephrine, sulcular incisions were made circum- ferentially around teeth #8 and #9. To create room for extrac- tion instructions, the crowns on teeth #8 and #9 were reduced (Fig 2a). Teeth #8 and #9 were extracted atraumatically using a piezosurgical insert and ser- rated universal maxillary forceps (Figs 2b-2c). Degranulation of the sockets was performed us- ing a carbide finishing bur and Neumeyer bur. A surgical guide was used to prepare the implant osteotomies, and proper position- ing was attained (Fig 3). After fi- nalisation of the osteotomy sites, rough-surfaced, internal hex 4 mm (diameter) x 13mm (length) implants were placed into the #8 and #9 sites (NanoTite® Tapered Certain® Implant, BIOMET 3i, Palm Beach Gardens, Fla.) (Fig 4). Healing abutments were placed on the implants to prevent soft tissue and bony collapse during the period that extraoral fabrica- tion of the temporary prostheses occurred (Fig 5a). The orienta- tion of the implants was ideal, Aesthetic management of adjacent maxillary central incisors Extraction, immediate placement and immediate provisionalisation - a case pre- sented by Dr Michael Sonick For more information, contact BioHorizons Customer Care: 01344 752560 Email: infouk@biohorizons.com visit us online at www.biohorizons.com BioHorizons is known for using science and innovation to create unique implants with proven surgical and aesthetic results. Laser-Lok microchannels exemplify our dedication to evidence-based research and development. The effectiveness of Laser-Lok has been proven with over 15 years of in vitro, animal, and human studies at leading universities.† This patented precision laser surface treatment is unique within the industry as the only surface treatment shown to inhibit epithelial downgrowth, attract a true, physical connective tissue attachment to a predetermined zone on the implant and preserve the coronal level of bone; long term.‡ Laser-Lok is currently available on Tapered Internal, Single-stage, and Internal Implants. Laser-Lok® dental implant at 8 years post-restoration showing superior crestal bone & tissue maintenance. aesthetics enhanced by technology † Clinical References available. ‡ Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant. M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim. The International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008. SPMP09074 REV A MAR 2009 Laser-Lok® microchannels Case courtesy of Cary A. Shapoff, DDS (Surgical); Jeffrey A. Babushkin, DDS (Restorative)