Australasian Dentist Issue 93

CATEGORY 52 AUSTRALASIAN DENTIST LINICAL Immediate loading protocol with Neoss ProActive ® Edge implant to replace a missing single tooth in the posterior maxilla By Dr Franco Rizzuto, Italy Patient: A 69-year old woman in good health. Clinical situation: Missing upper premolar with buccal bone resorption resulting in an apparent gingival defect. Treatment plan: To replace the missing tooth with a Neoss ProActive® Edge implant applying an immediate loading protocol in conjunction with autologous connective tissue augmentation. Female patient needed replacement of a missing second upper left premolar (Figure 1).The clinical examination showed evident buccal bone loss in the area (Figure 2 and 3). Intraoral scanning (Figure 4) and CBCT examination (Figure 5) was performed for treatment planning. The CBCT clearly showed the buccal defect, a bone thicknesses of 6 mm in buccal-palatal direction, and a bone height of 15 mm. It was decided to correct the buccal defect without bone augmentation. Instead, soft tissue augmentation using a roll flap procedure was performed to increase the buccal soft tissue volume. A buccal muco- periosteal incision was made (Figure 6) followed by de-epithelialization of the raised flap (Figure 7) and finally rolling and securing the flap to the buccal side. A customized surgical guide was made and used with the initial 2.2 mm drill (Figure 8). After the initial drill, the implant site preparation was finalized using a ∅ 4.0 mm countersink (Figure 9) followed by placement of a 4.0×13mmNeoss ProActive® Edge implant (Figure 10). Insertion torque Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9