Australasian Dentist Magazine Sept-Oct 2021

Category 92 Australasian Dentist T he following clinical case report describes a successful immediate replacement of a single tooth restoration of a maxillary first molar using the Straumann ® TLX Implant. The thread design of the body, combined with the classic Tissue Level neck design, allowed for optimal primary stability and placement of an immediate provisional. The TiZi alloy and the SLActive ® surface allowed for final restoration to be delivered two and a half months after implant placement. Initial situation A 48-year-old female patient presented to the IUSDCenter for Implant, Aesthetic and Innovative Dentistry with an unrestorable maxillary first molar (Fig. 1). The patient had no significant medical history and was not a smoker. Her overall oral health was good, with good oral hygiene. Initial clinical evaluation showed adequate inter-occlusal and medio-distal prosthetic space (Fig. 2). No infection was present, and the soft tissues were of medium thickness, with no recession, and no signs of inflammation. She had a medium smile line and realistic aesthetic expectations. The radiographic assessment showed very divergent roots, no periapical lesions, >4 mm apical to the apexes of the roots, and the presence of a wide inter-septal bone. (Figs. 3,4) Treatment planning Intraoral scans of her remaining dentition and virtual occlusal records were taken with an intraoral scanner (Virtuo Vivo™; Institut Straumann AG). Digital Imaging and Communications in Medicine (DICOM) files from CBCT imaging and a Standard Tessellation Language (STL) file from the intraoral scan were imported into an implant planning software program (coDiagnostiX ® ; Institut Straumann AG). Diagnostic waxing was completed in the same software program (Fig. 5). The surgical plan was developed using the coDiagnostiX ® software, with the aim of simulating an immediate implant placement (TLX WT Ø 5.5 x 8 mm; Institut Straumann AG). After careful evaluation, all factors considered were positive for the indication of flapless tooth extraction, and immediate placement of a Straumann ® TLX implant, with DBBM+C (deproteinized bovine bone mineral + collagen) graft on the remaining socket gaps (Figs. 6-9). Following the completion of the surgical plan, the file was imported into TLX for Immediate replacement of single maxillary molar clinical By Prof. Waldemar D. Polido, DDS, MS, PhD, Prof. Wei-Shao Lin DDS, PhD and Prof. Dean Morton DDS, MS, USA. Fig. 01 Initial Buccal View Fig. 02 Initial Occlusal View Fig. 05 coDiagnostiX Plan Fig. 06 Planned Implant and crown position Fig. 07 Guide design Buccal Fig. 08 Guide design Occlusa Fig. 09 Template for guided surgery Fig. 03 Initial periapical Fig. 04 Initial CBCT view a computer-aided design and computer- aided manufacturing (CADCAM) software program (CARES ® Visual; Institut Straumann AG) to design a provisional restoration with prefabricated implant screw access. The provisional restoration was 3D-printed with ceramic filled hybrid material (Figs. 10-13).

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