Replacement of a missing posterior tooth in the mandible (isy by CAMLOG) Implants are generally regarded as being a high-end therapy involving relatively high costs. In the quest for economical treatment strategies with first class quality, the isy Implant by CAMLOG has proven to be an excellent offering. The philosophy of the system is to simplify treatment and thus reduce costs. isy by CAMLOG consists of only a few components. The simplified surgical protocol and the lean processes save considerable time and costs in daily dental practice. Implant insertion is reduced to three drilling sequences and is concluded with a single patient form drill included with each implant set. A pre-mounted implant base is used as insertion post and also as base for the gingiva former and the multifunctional cap. Case presentation The isy Implant was designed for standardized implant treatment and provides a straightforward approach to the solution. When used in the right indication, as in the following case study, this implant provides an economically appealing option. The case study presents the prosthetic restoration with an implant after loss of a posterior tooth in the mandible. Authors: Dr. Manfred Wolf, Dr. Daniel Rein Indication: replacement of a missing posterior tooth in the mandible April 2, 2015 1
Fig. 1 Fig. 4 Fig. 2 Fig. 25 Fig. 3 Fig. 1: initial situation: the first molar in the left mandible is missing. The gap is to be filled prosthetically with an implant. The patient wished for the most simple treatment possible. Fig. 2: the panorama-x-ray prior to therapy shows sufficient bone height for the insertion of an 11 mm isy Implant. 2
Fig. 4 Fig. 25 3 Fig. 34 Fig. 3: minimally invasive exposure of the alveolar ridge. The bone is exposed with a marginal lingual relief cut of the planned implant position. Fig. 4: the mucosa and periosteum are mobilized and flapped. To keep the alveolar ridge exposed during surgical intervention, the mucosal flaps in the buccal region can be retained with small sutures. 3
Fig. 32 5 Fig. 5: the isy Surgical and prosthetic set includes the surgical instruments necessary for preparation of the implant bed and can be sterilized inclusive of contents. 4
Fig. 21 6 Fig. 31 27 Fig. 6: the implant position is marked after mobilizing and fixing the mucoperiostal flap. The cortical bone is slightly center-punched with the round bur which simplifies placing of the pilot drill. Fig. 7: pilot drilling defines the depth and axis of the implant site. The isy Pilot drill is fitted with depth markings. The lower edge of the markings corresponds to the implant length (9, 11 or 13mm). 5
Fig. 32 8 Fig. 8: the isy Direction and depth indicators are inserted into the drill holes for orientation purposes and depth and alignment checked. Then the preparation of the implant bed can be completed with the isy Single patient form drill and the tap. 6
Fig. 98 Fig. 910 Fig. 9: the isy Implant can be removed directly from the holder using the implant insertion tool. To this purpose, the insertion tool is inserted into the implant base until it audibly snaps into place under slight pressure. Fig. 10: Insertion of an isy Implant (5.0 x 11 mm). The implant is placed in the implant bed using the insertion tool, inserted manually and given its final position with the isy Torque wrench (epicrestally). 7
Fig. 10 11 Fig. 11 12 Fig. 11: the inserted implant. The implant base acts as basis for the gingiva former and the temporary restoration respectively. Fig. 12: after cleaning of the implant base, the before shortened multifunctional cap is mounted. The cap now acts as base for the chairside fabricated temporary restoration. Alternatively, a gingiva former can be mounted on the implant. 8
Fig. 10 13 Fig. 11 14 Fig. 13: the temporary crown has been prepared such that it is hollow inside and fits on the multifunctional cap. The crown is lined with resin and the cavity filled completely. Fig. 14: finishing the temporary crown with a silicone polisher. Then the crown is polished in the usual manner. 9
Fig. 12 15 Fig. 13 16 Fig. 15: the temporary crown (on multifunctional cap) is mounted on the implant base by applying slight pressure. Fig. 16: to ensure uninterrupted healing, the crown is placed without contact to the antagonist dentition taking into account the occlusion. The temporary implant-supported crown does not function through intercuspation nor the forward or sideward movements. 10
Fig. 12 17 Fig. 13 18 Fig. 17: the inserted temporary restoration. Neither the crown nor the implant are loaded under static or dynamic occlusion. Fig. 18: panorama x-ray after insertion and restoration of the implant with a temporary crown. The patient's wish for a cost-effective prosthetic implant restoration was fulfilled with the isy by CAMLOG in an efficient manner. A metal-ceramic crown on an isy Abutment is planned as final restoration. 11