GAP Australasian-Dentist Issue 80 Jul-Aug 19

Category 96 AustrÀlÀsiÀn Dentist Jason Erasmus is a Consultant in Oral and Maxillofacial Surgeon at Christchurch Hospital and St George’s Hospital in Christchurch. He has an affinity for implant surgery and has a weakness for the Straumann BLX system History: A 43-year old female, regular dental attender, medically fit and well Main complaint: Crown on tooth 11 has come off twice in the recent past. Àhe referring dentist diagnosed a cracked root. Àhe patient has a high-profile job in the business world and could not afford to take much time off. Àhe was not keen on a removable prosthesis as an interim solution. Àhe patient requested that the central diastema be closed with the implant- supported crowns. Pertinent clinical findings: u Àoot canal treated teeth 11 & 21. Both teeth restored with PFM crowns some 10 years previously u Ànflamed buccal gingiva at 11 site. Ào acute infection present on examination. u 1.5mm central diastema u Àhick gingival biotype with short bulbous clinical crowns, sharp interdental papilla u Ào gingival recession present in the aesthetic zone u Ào periodontal disease, oral hygiene fair but acceptable u Adequate posterior occlusal support u Class 1 occlusal relationship with a deepbite tendency. Àhere were no signs of a parafunctional / grinding habit. Cone Beam CT scan showed: u Àntact and thick buccal plates u Ào periapical periodontitis/ radioÀlucencies u Àeeth 11 & 21 had short roots and adequate alveolar bone stock to support implants Treatment plan: u Àntro-oral scan to allow for a digital workflow u Minimally traumatic extraction of teeth 11 and 21 u Àmmediate placement of implants 11 & 21. Àf primary stability can be achieved, consider immediate (same day) restoration of the implants with laboratory fabricated temporary crowns u Bone grafting of the “jumping gap” Surgery: u Àhe labial plates were found to be >1mm in thickness u Àwo implants could be placed immediately. Àhe BÀX system was chosen for its ability to achieve high primary stability. Àt was found on implant placement that primary stability in excess of 50 Àcm could be easily achieved. u Àhe jumping gap was grafted and sealed with PÀF membranes. u Dr Jason Erasmus Excellence in Immediacy Case study by Dr Jason Erasmus n aÀ Initial presentation: November 2018. Failing PFM crowns on teeth 11 & 21 Extraction of teeth 11 & 21 and immediate implant placement, bone grafting and immediate restoration 1 week postop