Australasian Dentist Issue 92

CATEGORY 56 AUSTRALASIAN DENTIST Maxillary molar replacement using a Straumann ® TLX implant and an immediate restoration A clinical case report by Leandro Nunes, Brazil T he attempts to provide a better patient experience have led to the development of improved manufacturing technology, innovative techniques, and a better understanding of the biological aspects through clinical and pre-clinical studies. The immediate loading of implants has now become a reality, and these treatments are frequently used in the anterior maxillary area. However, the insertion of dental implants simultaneously with a provisional restoration can also provide benefits in the posterior areas, with a shorter time to the recovery of the masticatory function 1 . To this end, the estimation of the risk of the treatment result and effective treatment planning are crucial. It is essential to perform an analysis of the patient’s medical condition, bone availability, soft tissues, and desired tooth shape, and take into consideration our patient’s needs and expectations. The following case report describes the replacement of a single upper molar with the new Straumann® TLX implant in a fully healed site (Type 4, ITI implant placement) and the immediate rehabilitation with a provisional restoration. Initial situation A healthy, 40-year-old female non-smoker presented at our clinic with a missing maxillary molar. Her primary wish was to recover her masticatory function as soon as possible, because her condition prevented her from eating properly and was affecting her quality of life. Her dental history revealed that the tooth had been lost due to a vertical fracture a couple of months before. Since this incident happened during the Covid-19 lockdown, she had not been able to receive the complete treatment of the site. The intraoral examination showed the missing upper right firstmolar.The patient’s periodontal condition was healthy, and her oral hygiene was classified as good (Figs. 1, 2). The pre-operative CBCT revealed sufficient vertical andhorizontal availability for an implant placement at site #16 and no risk of damage to the surrounding anatomic structures (Fig. 3). Treatment planning Prosthetic-driven planning was considered and close communication ensured between Leandro Nunes the patient, the prosthodontist (Dr. Cristiane Juchem), and the dental technician (Lisiane Merlin). After the various treatment options were discussed with the patient, she opted for implant placement and provisional restoration at position #16. The clinical and radiographic evaluation showed adequate conditions for implant placement at the healed site. Furthermore, the CBCT for diagnosis revealed no need for a bone augmentation procedure. Therefore, a Straumann® TLX RT SP (Standard Plus) Roxolid® 3.75 x 10 mm with immediate provisionalization was planned only if the desired primary stability was achieved. The Straumann® TLX Implant System offers fully tapered tissue level implants (TLX) that are designed for high primary stability and immediate treatment procedures. Surgical procedure Local anesthesia was infiltrated using articaine (4%) with epinephrine. Mid- crestal and intrasulcular incisions were performed without a vertical release. The flap was raised to expose the bone in the area of tooth #16 (Fig. 4). Following the manufacturer’s surgical protocol, a Straumann® TLX RT SP (Standard Plus) Roxolid® 3.75 x 10 mm was placed in a prosthetically driven position. A minimum gap of 1.5 mm from the implant LINICAL The introduction of dental implants for the replacement of missing teeth disrupted the era of dental prosthetic dentistry by providing the possibility of replacing a missing tooth with a fixed restoration without the need for the support of the adjacent teeth. During the beginning of the era of implant dentistry, two-stage procedures were followed by a waiting period of three to six months from the day of the surgery to the loading [1] . Figure 1 Figure 2 Figure 3