Australasian Dentist Magazine Nov Dec 2021

Category AustrAlAsiAn Dentist 67 Fig. 09: Ø 2.2mm alignment confirming three- dimensional position Fig. 10: Osteotomy with Ø 2.8mm drill u Minimally traumatic tooth extraction u immediate implant placement (straumann ® tlX ® , Ø3.75mm x 12mm) u intra-oral scanning u temporary crown design and chairside milling u immediate provisional crown in function u After osseointegration and soft tissue maturation proceed with final crown. Surgical procedure the surgical procedure was carried out under conscious sedation with local anaesthetic, and routine sterile preparation for surgical procedures were followed. to maintain the gingival and surrounding walls as preserved as possible, a flapless minimally traumatic approach to the extraction was chosen by splitting the roots in different directions (Fig. 04). extra precautions were made not to inflict any trauma, even by the suction device on the papilla and any surrounding soft tissue. A simple orthodontic elastic is placed around the adjacent teeth to delimitate the buccal and lingual red zone margins that should not be encroached upon. it was possible to verify solid interradicular bone availability (Fig. 05) extending further the limits of the root apexes allowing for a centrally oriented osteotomy. the implant bed preparation started with the use of the needle Drill at 800 rpm, followed by the Ø2.2mm and Ø2.8mm drills (Fig. 06 to 10). the implant was placed with the use of ratchet and torque control reaching the desired final position with 50ncm torque value (Figs.11, 12 and 13). the sockets are then augmented with bovine derived bone substitute impregnated with a-PrF finalized by sutures to keep the a-PrF application immobile, with a 3mm healing abutment in position (Figs. 14, 15, 16 and 17). the patient also received intra operative iV antibiotic with 4 mg dexamethasone and received standard post operatory care with analgesics, chlorhexidine mouthwash and antibiotic for 5 days. Prosthetic procedure the patient was sent to the prosthodontic and the immediate restoration technical work followed a digital workflow that included an intraoral scanner DW (iOs; triOs Pod, 3shape, Copenhagen, Denmark) and CAD/CAM processing using straumann CAres ® Digital solutions (Dental Wings, Montreal, Canada). A PMMA crown was milled and cemented to a prefabricated Fig. 11: Ø 3.75 x 12mm TLX Implant ready for pick up on the vial cap Fig. 12: Direct implant pick up with insertion driver Fig. 13: TLX Implant insertion Fig. 14: Implant in final position with bone augmentation Fig. 15: Implant in final position with L-PRF protecting the bone substitute granules Fig. 16: Sutures to stabilize the biomaterials in place Fig. 17: Periapical radiograph after implant placement Fig. 18: Temporary crown liniCal