Lifecore Dental

Prima™ Implant System
Clinical Case Report, No. 5
Esthetic Replacement of
Failing Teeth #8 and #9
Using Lifecore’s PrimaConnex®
Implant System
Douglas H. Mahn, DDS, Periodontist
Manassas, Virginia, U.S.A.
and
Mariano A. Polack, DDS, MS, Prosthodontist
Gainesville, Virginia, U.S.A.
Lifecore Dental
Purposeful Innovation
Manufacturer
Lifecore Biomedical, Inc.
3515 Lyman Blvd.
Chaska, MN 55318 USA
Call: 1-800-752-2663
Fax: 1-800-651-8521
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Lifecore Biomedical, SpA
via A. Fleming, 19
37135 Verona, Italy
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Alfter, Germany
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Fax: +49-2222-977356
Outside the USA
Call: +1-952-368-4300
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Särö, Sweden
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Beauzelle, France
Call: +33-5-62-21-40-45
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Lifecore Dental
Purposeful Innovation
Email: [email protected]
www.lifecore.com
© Lifecore Biomedical, Inc. 2007
7/07
4410-0189
Pre-op evaluation
Case Overview
4 months post extraction
A
Figure
10
11
Temporary abutment prepared intra-orally
Clinical Case Report, No. 5
Surgical Diagnosis
Prior to surgical treatment, an interim removable partial
denture (a “flipper”) and an implant guide splint were
fabricated. At the first surgical appointment, teeth #8 and #9
were removed (Fig. 3). An allograft was placed into the sockets
and a barrier membrane was placed over the grafted sites.
Following approximately 4 months of healing, the surgical site
was found to have healed well (Fig. 4). Clinically, good residual
ridge height and width was maintained. Radiographic
evaluation gave the appearance of good bone fill in the
extraction sites (Fig. 5). Implant osteotomies were performed
in sites #8 and #9 using the Lifecore Prima implant surgical kit.
Care was taken not to impinge on either the incisive foramen
or the adjacent lateral incisors. Parallelism was achieved using
parallel pins and implant drills. The 4.0 x 13mm, regular
9
One month post-op radiograph
and healthy gingival tissue
Figure
Surgical guide verification of placement
diameter, straight, RBM textured, internal connection implants
(PrimaConnex, Lifecore Biomedical) were placed into #8 and #9
(Fig. 6). Impression post screws were placed into the implants
to provide immediate verification of implant parallelism. The
use of the impression post screws on the implants and the
implant guide stent provided by the restorative dentist
confirmed proper implant angulation (Fig. 7). The implants were
not placed below the osseous crest due to the concerns of
overly elongated teeth and the ability to keep deep gingival
cuffs cleansable.
The surgical site was found to be healing well after about 1
month (Fig. 8A). The gingiva was healthy, pink, and free of
inflammation (Fig. 8B). Removal of the healing abutment
revealed a healthy gingival cuff with a natural emergence
profile (Fig. 9). With the exception of blunted central papillae,
good gingival contours were achieved.
Implants inserted
B
8
Figure
7
Figure
Several treatment options were discussed with the patient. The
patient was only interested in replacement of teeth #8 and #9
using dental implants. In discussions with the patient, she was
informed due to the difficulties in this type of case, elimination of
the black triangle might not be possible.
Figure
4 month post-op
radiograph
A 46-year-old nonsmoking female in good health presented with
the chief complaint of long and mobile front teeth. In addition,
she was concerned about the large black triangle between teeth
#8 and #9 (Fig. 1).
Clinical evaluation found teeth #8 and #9 to have class II+ mobility.
The teeth had long clinical crowns and severely blunted papillae
between them creating a large dark triangle. The anterior alveolar
ridge had a significant buccal angulation. Radiographically, teeth
#8 and #9 had wide, but resorbed roots (Fig. 2). It was also
observed that the incisal foramen was large and adjacent to the
mesial aspects of the roots.
Figure
Figure
Mariano A. Polack, DDS, MS, Prosthodontist
Gainesville, Virginia, U.S.A.
Extraction of #8 and #9
6
5
Figure
4
Pre-op radiograph
Figure
Douglas H. Mahn, DDS, Periodontist
Manassas, Virginia, U.S.A.
3
Figure
2
Figure
1
Natural emergence of soft tissue
12
Figure
Esthetic Replacement
of Failing Teeth #8 and #9
Using Lifecore’s PrimaConnex®
Implant System
One year post-op
radiograph
Restorative Diagnosis
To meet the patient’s esthetic expectations, teeth #7 and #10
were prepared for all-ceramic crowns. Two PMMA Temporary
Abutments (PrimaConnex, Lifecore Biomedical) were secured
with a titanium-nitride coated screw to the implants and prepared
intra-orally in order to fabricate a provisional restoration (Fig. 10).
Approximately two months later, the provisional restorations and
abutments were removed, and contoured impression posts
(PrimaConnex, Lifecore Biomedical) were connected to the
implants. Custom abutments were modified and cast with a
porcelain-compatible alloy. The custom abutments were covered
with a layer of opaque to aid in esthetics. The abutments were
torqued to 30Ncm with the Quad Driver and the four all-ceramic
Zirconia restorations were cemented with self-etching adhesive
cement. The final radiograph (Fig. 11) and clinical situation
Final restoration one year post-op
(Fig. 12) of the implant and prosthetic reconstruction one year
post-op shows stable bone levels and healthy soft tissue.
Conclusion
Esthetic restoration of adjacent dental implants, especially in sites
#8 and #9, represents among the most challenging implant cases.
Immediate implant placement and atraumatic surgical design
have become common and successful modes of therapy in
properly selected cases.
Despite the difficulties in this case, a highly esthetic result was
obtained with healthy and esthetic gingival contours, while the
secure internal connection of the implant system utilized will
maintain the mechanical stability of the restorations.