Australasian Dentist Issue 89

Category AustrAlAsiAn Dentist 85 is up to 2.9 mm at a depth of 15 mm. An implant with size 3.5x15 mm (Anyridge, MegaGen implant Company) is placed through the guide and an initial stability of 37 ncm is achieved with an isQ value of 77. Directly i have delivered the on beforehand manufactured PMMA crown cemented on a titanium abutment. there is a fenestration of the alveolar bone at the labial side, but this is inside of the bony envelope. therefor the need to harvest an autogenous bone block from the ramus is not crucial. the decision has been made to use synthetic bone particles when possible in this case. A synthetically manufactured mixture of 65% beta tricalcium phosphate and 35% calcium phosphate mixed with sterile saline (0.9 sodium chloride) is grafted on top of the implant and bone defect. in four minutes, the graft is cured and a vertical matrass suture (6-0 resorbable monofilament) placed deep on the labial flap which stabilizes the flap. two additional vertical matrass sutures are placed mesial and distal through the papillas. the two releasing incisions are sutured with single sutures. A postoperative peri apical radiograph is made after surgery. On the upper part around the implant, the synthetic bone particles are clearly visible. sutures are removed in two weeks; the surgical site has healed uneventful. Another ten weeks of healing is necessary for the implant to osseointegrate as the turnover of the synthetic bone particles to host bone. the soft-tissue has to stabilize as well. in three months, the patient returns to the practice. the temporary crown is unscrewed from the implant. some particles are visible in the soft tissue of the emergence and cervical profile. Digital impressions are made with an intra oral scanner (trios 3, 3shape). the ceramic crown is a full zirconia crown with porcelain veneering on the labial side, in lab cemented on a titanium base (Zrgen, lInICal Figure 3 Papilla preservation flap Figure 6 Implant is delivered through the guide Figure 9 Flap sutured with 6-0 resorbable monofilament Figure 12 Emergence profile 3 months post operative Figure 4 After curettage of the alveolar bone Figure 7 Implant in correct position with high initial stability Figure 10 Immediate postoperative x-ray Figure 13 Cervical profile 3 months post operative Figure 5 Guide in place Figure 8 Ethoss synthetic bone particles are grafted Figure 11 Two weeks post operative after suture removal Figure 14 Scan abutment in implant for digital impressions