immediate implantation and loading with Paltop Osteotomes for bone expansion Case Study

Transcription

1 immediate implantation and loading with Paltop Osteotomes for bone expansion Case Study

2 Osteotomes for bone expansion 2

3 This 55-year-old female patient presents with a failing maxillary cuspid. 3

4 A fistula can be seen coming from the point of horizontal fracture in the tooth. 4

5 Radiographic evaluation demonstrates adequate bone for implant placement. 5

6 Following extraction, the initial osteotomy is begun in the palatal aspect 3/4 of the way down apically in the extraction socket to prevent apical fenestration thru the buccal plate. 6

7 A fixed provisional as well as a transitional removable partial denture are prepared for the surgical visit. Implant stability following implant placement will determine which provisional may be used. 7

8 Upon removal of the crown, it is apparent that extraction of the cuspid is the appropriate treatment plan. 8

9 The Benx extraction tool is used to atraumatically remove the cuspid root and preserve the buccal plate. 9

10 The Benx tool atraumatically removes the cuspid. 10

11 The socket is debrided with a round bur. 11

12 The starter drill is guided by the surgical guide to correct prosthetically driven implant placement. 12

13 Handpiece driven osteotomes correspond to and replace twist drills, these osteotomes are designed for bone expansion and compaction. 13

14 The depth from the free gingival margin until the beginning of the buccal cortical bone is measured to determine correct preparation depth with the osteotome. 14

15 Once the initial osteotomy depth and orientation is made with the 2mm drill, the osteotomy expansion and completion can be done with the osteotomes in soft bone. 15

16 The osteotome can be driven to the final depth with the torque driver. 16

17 A 5mm diameter implant was chosen to support this extraction, immediate implant placement, immediate provisionalization of a cuspid. The prosthetic connection for this 5mm implant is the same dimensionally as the 3.75mm and 4.2mm diameter implant so a good prosthetic result can be obtained. 17

18 There is a secure easy connection from the implant driver to implant. 18

19 Correct prosthetic orientation is maintained while driving the implant to its final position. 19

20 Final seating is done with the torque driver 20

21 Final seating is done with the torque driver 21

22 A peak abutment is used to make a screw retained provisional directly to the head of the implant. Retention grooves are cut into the peak abutment and a cotton tip applicator is placed into the screw access hole. 22

23 The provisional shell is tried in place. 23

24 The acrylic shell is filled with acrylic and seated to place. The cotton tip applicator prevents acrylic from going into the screw access hole. After curing, the provisional is removed. Voids in the acrylic can be seen. 24

25 A subepithelial connective tissue graft is harvested from the palate. 25

26 A pocket is created on the buccal and the connective tissue graft is positioned to thicken the soft tissue. 26

27 The connective tissue graft creates a cuspid eminence. 27

28 Acrylic is added to the voids in the provisional and the concave shape of the peak abutment is maintained thru the provisional. 28

29 The distal papilla is held out due to the thickness of the connective tissue graft, but will predictably fill in due to the position of the underlying interceptal bone. A screw-retained provisional ensures a secure fit when maintaining retrievability. 29

30 The occlusion is generously relieved in all functional movements. The use of a 5mm diameter implant is a distinct advantage in the immediate non-functional loading of a cuspid implant. It usually cannot be done due to prosthetic abutment diameter considerations. The uniform prosthetic platform allows for an esthetic prosthetic result with the advantage of a 5mm diameter implant. 30

31 At 2 weeks post-op, the free gingival margin is in good position and the papilla are falling into place. 31