CATEGORY 94 AUSTRALASIAN DENTIST CLINICAL CASE 1 A 40-year-old male patient was referred for tooth extraction and immediate implant placement at site #4 (1.5. FDI). e CBCT scan showed a breakage of the buccal cusp, where the cracking ended deep under the bone level. Due to an adequate bone socket and density it seemed to be favourable to place an implant immediately (Fig 1). e surrounding soft tissue morphology was aesthetic and we aimed to preserve it for the prosthetic phase. (Fig 2-1, Fig 2-2). Intraoral scanning was performed using a Medit I700 intraoral scanner, and a surgical guide was designed using MegaGen R2GATE software, which is capable of exporting not only the planned surgical guide but also an emulated digital model that shows the expected position of the future implant. With the help of the digital pre-scan and emulated digital model, we were able to design an anatomical healing abutment. For the temporary abutment design, free 3D design software was used (Mesh mixer). e designed abutment was exported in a stl format and milled from zircon. We chose zircon as the temporary material because of its biologically bene cial properties. e pre-milled zircon head was then cemented to an engaging ZrGEN abutment (MegaGen) (Fig 3-1, Fig 3-2). smaller to create space for a connective tissue graft. After atraumatic extraction, the implant site was prepared into the solid palatal wall with the help of the pre-printed surgical guide. A 4.5x10mm MegaGen AnyRidge implant was then placed with an insertion torque of 40Ncm. It’s important to both drill and place the implant through the guide for maximal accuracy (Fig 4, Fig 5). Gábor Berkei Emergence profile shaping, the clean way Pre-milled individual zircon healing abutment By Gábor Berkei DMD, Helvetic Clinic, Budapest ABSTRACT Digital dentistry and guided implantology are not only a fancy new way of placing implants to reduce the treatment time and increase the accuracy, but also o er endless possibilities for soft tissue shaping. e best way to shape the soft tissues after immediate implantation is to preserve them. e traditional way is to make an individual healing abutment right after implant placement using a temporary abutment and composite material. Yet, while individual healing abutments can do the job perfectly, there seems to be a contradiction between ensuring a clean and sterile implant placement and then pouring a owable composite directly into the extraction socket. is case series presents an alternative way to produce an individual healing abutment before the implant placement, allowing it to be sterilized before handling and the choice of more biocompatible, tissue-friendly material than composite. With digital planning and guided implant placement, this can be a predictable way to achieve a perfect emergence pro le. Fig 1. CBCT showing breakage of buccal cusp Fig 2-1, Fig 2-2. Good soft tissue condition worth preserving Fig 3-1, Fig 3-2. Digital plan & milled zircon abutment e temporary abutment design followed the cervical shape of the extracted tooth at the marginal gingiva level. We also modi ed the size and designed the diameter approximately one millimetre e gap between the implant body and the socket wall was lled with small particulate xenograft material to prevent any resorption of the thin buccal bone. While bone preservation is important, it’s strictly connected to the soft tissue condition. So, it’s advantageous to thicken the tissue phenotype with an intrasulcular connective tissue graft. A thin ‘wormlike’ epithelized palatal graft was taken from the molar region of the palate. e graft was then extraorally de-epithelized with a help of a scalpel. e well-prepared connective tissue graft was xed in the sulcus on the buccal side using 7-0 resorbable mono lament sutures (Fig 6, Fig 7). Fig 4. Guided implant placement using R2 Gate system Fig 5. X-ray control of placed implant
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