Case Study. Case # 1 Author: Dr. Suheil Boutros (USA) 2013 Zimmer Dental, Inc. All rights reserved. 6557, Rev. 03/13.

Transcription

1 Placement of a Zimmer Trabecular Metal Dental Implant with Simultaneous Ridge Augmentation and Immediate Non-Functional Loading Following Tooth Extraction and Orthodontic Treatment for Implant Site Development Case # 1 Author: (USA)

2 Pre-operative buccal view shows a missing maxillary right lateral incisor provisionally restored with a composite pontic veneer during adult orthodontic treatment for implant site development.

3 Pre-operative periapical radiograph shows the healed extraction site with the provisional composite pontic veneer in place supported by orthodontic wire.

4 Buccal view of the edentulous site after removing the provisional composite pontic veneer and orthodontic wire.

5 The edentulous ridge is surgically exposed and an osteotomy is sequentially prepared using internally irrigated drills in graduated diameters and copious external irrigation. During the procedure, a depth gauge is placed into the osteotomy to ensure parallelism with the adjacent dentition and to measure the depth of drill penetration.

6 Further flap reflection after preparation of the osteotomy reveals an undercut in the alveolar process.

7 A Zimmer Trabecular Metal Dental Implant, 4.1 mm x 13 mm, is threaded into the osteotomy utilizing its fixture mount with a hex instrument and surgical screwdriver handle.

8 Buccal view shows the Zimmer Trabecular Metal Dental Implant fully seated in the osteotomy. Note that the fixture mount has achieved parallelism with the adjacent teeth.

9 The fixture mount is removed from the implant and prepared for use as a provisional abutment. Note the implant s lead-in bevel and internal hex connection.

10 Puros Cortico-Cancellous Particulate Allograft is hydrated prior to use.

11 The prepared fixture mount is attached to the implant and its screw access hole is occluded with composite material. Puros Cortico-Cancellous Particulate Allograft is placed in the ridge defect and covered with a barrier membrane.

12 A composite crown is provisionally cemented onto the temporary abutment. The soft tissues are mobilized for tension-free closure and sutured around the provisional restoration.

13 Buccal view of the surgical site at suture removal 14 days post-operative.

14 Post-operative periapical radiograph shows the implant and provisional restoration in place.

15 3 month post-operative buccal view of restoration.

16 3 month post-operative buccal view of restoration.

17 3 month post-operative periapical radiograph showing implant and final restoration.

18 10 month post-operative buccal view of surgical site.

19 10 month post-operative full buccal view.

20 10 month post-operative periapical radiograph shows the implant and final restoration.

21 Immediate Placement and Functional Loading of a Zimmer Trabecular Metal Dental Implant in the Maxillary Esthetic Zone Case # 2 Author:

22 Pre-operative buccal view shows a fractured maxillary right central incisor.

23 Pre-operative periapical radiograph shows the intact root of the fractured maxillary right central incisor.

24 The root tip is gently split and removed in segments to preserve the surrounding bony architecture. Prior to osteotomy preparation, the socket is debrided to remove remaining root fragments and any remaining granulation tissue.

25 The socket is sequentially formed and enlarged to receive the implant using internally irrigated drills in graduated diameters and copious external irrigation.

26 The Zimmer Trabecular Metal Dental Implant is delivered to the osteotomy using its fixture mount.

27 The Zimmer Trabecular Metal Dental Implant is placed using a hex instrument in a reduction contra-angle at slow speed.

28 The Zimmer Trabecular Metal Dental Implant in place.

29 After implant placement, the fixture mount is removed from the implant, prepared as a provisional abutment, and then reattached to the implant.

30 Circumferential voids around the top of the implant are augmented with hydrated Puros Cancellous Particulate Allograft. The soft tissues are mobilized and approximated for tension-free suturing.

31 Immediate temporary restoration at the time of implant placement.

32 Provisional restoration two weeks post implant placement.

33 Post-operative periapical radiograph shows the provisional restoration in place.

34 Final restoration ten weeks post implant placement and one week following final crown delivery.

35 Final radiograph ten weeks post implant placement.

36 Sinus Augmentation with Puros Cortico-Cancellous Particulate Allograft Mix and Immediate Placement of a Zimmer Trabecular Metal Dental Implant into a Fresh Extraction Socket Case # 3 Author:

37 Pre-operative occlusal view shows a fractured maxillary left 1 st molar.

38 Pre-operative periapical radiograph shows pneumatization of the sinus with a vertically resorbed residual ridge.

39 After tooth extraction, the facial plate is surgically exposed for subantral augmentation utilizing a lateral approach.

40 Access through the lateral sinus wall is performed utilizing the Sinus Lateral Approach (SLA) reaming instrument in a slow-speed handpiece.

41 After careful penetration through the lateral wall of the sinus, the reaming instrument is removed with the intact facial plate bone core.

42 Buccal view of the surgical site shows the Schneiderian membrane intact.

43 An elevator is used to carefully remove the Schneiderian membrane from the sinus floor for elevation prior to graft placement.

44 After mobilization of the Schneiderian membrane, the extraction socket is formed and enlarged to receive the implant by sequential cutting with internally irrigated drills and under copious external irrigation.

45 A CollaTape Wound Dressing was used to isolate the membrane and allow the placement of the graft material Zimmer Dental, Inc. All rights reserved. 6557, Rev. 03/13. 10/12.

46 Puros Cortico-Cancellous Particulate Allograft Mix is hydrated in sterile saline and bone, then gently packed into the sinus cavity.

47 A Zimmer Trabecular Metal Dental Implant, 4.7 mm x 10 mm, is placed into the osteotomy and graft material.

48 Zimmer Trabecular Metal Dental Implant in place.

49 The bone core is replaced into its location in the facial plate and the surgical site is covered with a piece of BioMend Absorbable Collagen Membrane.

50 Soft tissues are mobilized for tension-free closure and sutured in place Zimmer Dental, Inc. All rights reserved. 6557, Rev. 03/13. 10/12.

51 Post-operative radiograph shows the Trabecular Metal Dental Implant and sinus graft in place.

52 Healed site with submerged implant, three months post-operative

53 Implant uncovered and healing collar placed at four months

54 Final restoration, six months post-operative

55 Radiograph of Trabecular Metal Dental Implant with final restoration, six months after placement

56 Immediate Placement and Provisionalization of Two Zimmer Trabecular Metal Dental Implants in the Left Mandibular Posterior Jaw: One-Year Follow-up after Definitive Restoration Author: Dr. Markus Schlee (Germany)

57 Dr. Markus Schlee Pre-operative occlusal view of the left edentulous mandibular posterior ridge.

58 Dr. Markus Schlee After surgical exposure and sequential preparation of the osteotomies using graduate drills and copious internal and external irrigation, two Zimmer Trabecular Metal Dental Implants, 4.7 mm x 10 mm, and two Zimmer Trabecular Metal Dental Implants, 6.0 mm x 10 mm, were placed according to the Instructions For Use.

59 Dr. Markus Schlee Two implants were immediately provisionalized and definitively restored after two weeks with fully occluding, ceramometal restorations. Healing collars were placed on the most mesial and distal implants at the time of surgery for one-stage healing.

60 Dr. Markus Schlee Radiograph shows all four implants in place, with two immediately loaded implants that were definitively restored at two weeks.

61 Dr. Markus Schlee Occlusal view of all four definitively restored implants after one year of function Zimmer Dental, Inc. All rights reserved. 6557, Rev. 03/13. 10/12.

62 Dr. Markus Schlee Buccal view of four definitively restored implants shows excellent esthetics and soft tissue health after one year of function.

63 Dr. Markus Schlee Radiograph after one year of function shows stable marginal bone levels.

64 Bilateral Sinus Augmentation with Puros Cancellous Bone Allograft and Placement of Four Zimmer Trabecular Metal Dental Implants in the Edentulous Maxilla Author: Dr. Carlo Maria Soardi (Italy)

65 Dr. Carlo Maria Soardi The patient presented with a severely resorbed edentulous maxillary ridge.

66 Dr. Carlo Maria Soardi Computed Tomography (CT) scans shows pneumatized sinuses with minimal bone height available for dental implant placement due to the close proximity of the sinus floor.

67 Dr. Carlo Maria Soardi The sinus cavity was accessed utilizing a crestal window approach according to the technique of Carlo M. Soardi and Hom-Lay Wang (New Crestal Approach for Lifting Sinus in the Extremely Atrophic Upper Maxillae Clinical Advances in Periodontics. Posted online ahead of print on 28 th of March, 2012 at: filter=single&x=34&y=8

68 Dr. Carlo Maria Soardi Hydrated composite graft of Puros Cortical Particulate Allograft (80%) and Puros Cancellous Particulate Allograft (20%) materials is gently packed into the prepared cavity between the residual sinus floor and the elevated Schneiderian membrane.

69 Dr. Carlo Maria Soardi Buccal view shows the bone graft material in place. A collagen membrane is placed over the graft material, then the soft tissues are mobilized and sutured for tension-free closure.

70 Dr. Carlo Maria Soardi Post-operative CT scan shows significant gains in vertical height provided by the bilateral sinus grafts.

71 Dr. Carlo Maria Soardi Pre-operative view of the resorbed edentulous ridge after sinus graft incorporation.

72 Dr. Carlo Maria Soardi Surgical exposure of the edentulous ridge shows an intact but narrow alveolar process.

73 Dr. Carlo Maria Soardi Osteotomies were prepared according to the manufacturer s protocol and six implants were placed. Two HA-coated Tapered Screw-Vent Dental Implants, 3.7 mm x 10 mm, were placed in the lateral incisor area, since it could be best accommodated by the amount of available native bone without bone grafting. In the remaining four sites, Zimmer Trabecular Metal Dental Implants were placed and augmented with a composite graft of Puros Cortical Particulate Allograft (80%) and Puros Cancellous Particulate Allograft (20%) materials.

74 Dr. Carlo Maria Soardi After implant placement, the fixture mounts are removed and surgical cover screws are threaded into the implants. The soft tissues are mobilized for tension-free closure and sutured.

75 Dr. Carlo Maria Soardi Post-operative CT scan shows six implants placed into the augmented maxillary sinuses.

76 Delayed Replacement of Maxillary Right 1 st and 2 nd Premolars with Tapered Screw-Vent and Zimmer Trabecular Metal Dental Implants in Low-Density Bone Case#1 Author: Dr. Edgard El Chaar (USA)

77 Dr. Edgard El Chaar CAT Scan of Patient A 60-year-old partially edentulous male with missing maxillary right 1 st and 2 nd premolars presented with a failed bridge in Type III to Type IV bone.

78 Dr. Edgard El Chaar Surgical exposure of the edentulous site showed a wide, flat ridge adequate for placement of two dental implants.

79 Dr. Edgard El Chaar During preparation of two implant osteotomies, Type III to Type IV bone was observed in the 2 nd premolar location, so a Zimmer Trabecular Metal Dental Implant, 4.7 mm x 11 mm, was delivered and placed in the site.

80 Dr. Edgard El Chaar Occlusal view of the surgical site shows a Tapered Screw-Vent Dental Implant, 3.7 mm x 11 mm, placed in the maxillary right 1 st premolar site and a Zimmer Trabecular Metal Dental Implant, 4.7 mm x 11 mm, placed in the 2 nd premolar site. Note the spacing between the implant and natural teeth.

81 Dr. Edgard El Chaar After healing collars were attached to the implants, the soft tissues were approximated and sutured around the healing collars.

82 Dr. Edgard El Chaar Post-operative periapical radiographs show the Zimmer Trabecular Metal and Tapered Screw-Vent Dental Implants during nonsubmerged healing.

83 Dr. Edgard El Chaar One year post-implantation and six months loading postrestoration. Final restoration. Additional Trabecular Metal and Tapered Screw-Vent implants were placed in the interim.

84 Sinus Graft Using the Crestal Approach and Replacement of a Maxillary Left 1 st Molar with a Zimmer Trabecular Metal Dental Implant Case#2 Author: Dr. Edgard El Chaar (USA)

85 Dr. Edgard El Chaar A 38-year-old male presented with a fractured maxillary left 1 st molar decayed in the furcation area.

86 Dr. Edgard El Chaar Occlusal view of a fractured and decayed maxillary left 1 st molar

87 Dr. Edgard El Chaar Periapical radiograph shows residual root fragments from the fractured maxillary left 1 st molar area.

88 Dr. Edgard El Chaar CAT Scan of patient with the following views, Panoramic, 3-D, Tangential, Cross section and Occlusial. Computed Tomography of the treatment site shows panoramic, three-dimensional, tangential, cross-sectional and occlusal views.

89 Dr. Edgard El Chaar Preparation of the extraction socket for placement of the dental implant. Root fragments were carefully removed using an atraumatic technique to preserve the surrounding bony architecture.

90 Dr. Edgard El Chaar Periapical radiograph of the paralleling post placed in the osteotomy to determine if an angle correction is needed.

91 Dr. Edgard El Chaar After preparation of the implant site, a 2mm sinus elevation is performed with osteotomies and grafted with Puros Cancellous Particulate Allograft. The completed osteotomy is ready for implant placement.

92 Dr. Edgard El Chaar A Zimmer Trabecular Metal Dental Implant, 4.7 mm x 10 mm, was placed in the extraction site. Its fixture mount will be replaced by a healing collar for a nonsubmerged surgical protocol.

93 Dr. Edgard El Chaar Puros Cancellous Particulate Allograft material is hydrated, then used to fill the remaining sockets and any additional voids around the implant. After filling, each sockets is occluded with CollaPlug Absorbable Collage Wound Dressing.

94 Dr. Edgard El Chaar Periapical radiograph shows the Zimmer Trabecular Metal Dental Implant and healing collar in place.

95 Dr. Edgard El Chaar Periapical radiograph taken at two months after the Zimmer Trabecular Metal Dental Implant placement shows a significant degree of bone densification around the implant Zimmer Dental, Inc. All rights reserved. 6557, Rev. 03/13. 10/12.

96 Dr. Edgard El Chaar Occlusal view at two months after the Zimmer Trabecular Metal Dental Implant placement

97 Dr. Edgard El Chaar Final restoration at four months post implant placement.

98 Dr. Edgard El Chaar Periapical radiograph of Trabecular Metal Dental Implant with final restoration. One year postplacement with over six months of functional loading.

99 This document is intended exclusively for physicians and is not intended for laypersons. Information on the products and procedures contained in this document is of a general nature and does not represent and does not constitute medical advice or recommendations. Because this information does not purport to constitute any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and advised individually, and this document does not replace the need for such examination and/or advice in whole or in part. Please refer to the package inserts for important product information, including, but not limited to, contraindications, warnings, precautions, and adverse effects.