Gap Magazine Implant Dentistry Today No 17

Implant Dentistry Today 28 conservative final drill-implant diameter difference of 1 mm (Figs. 14 & 15). Additional remarkable characteristics of this design include the diameter of the implant transport holder which is the same as the implant itself. This feature helps us to easily manage the implant insertion in situations where the implant is inserted close to another implant or into hard bone. As previously planned, the implant (grade 4 titanium) was placed partially outside the bone envelope. Thanks to its flat section, a possible vascular compression of the soft tissues was diminished (Figs. 16-19). The same procedure was followed on the contralateral side. Additional four conventional implants were placed on the anterior side. To increase the amount of keratinized tissue buccal to the implant, a palatal incision was made. The double pediculate partial flap aimed to make possible a first intention closure of the soft tissue. Finally, a mattress technique with a non-resorbable suture was performed (Figs. 20 & 21). In the lower jaw, four conventional implants on positions #32, #34, #42 and #44 were placed following the manufacture’s protocol. Prosthetic procedure The prosthetic workflow included the positioning of screw retained abutments (SRAs) and positioning transfers in order to perform an analog impression (Fig. 21). The delivery of the screw-retained temporary bridge was done in the same day and an X-ray control was taken. Treatment outcomes The clinical and radiographic one- year follow-up evaluations showed the outstanding outcomes of combining the use the ZAGA Concept for hard and soft tissue management and an implant design (Straumann Zygomatic implant ZAGA flat) with features adapted to the patient anatomy. Additionally, we could also appreciate the excellent bone and soft tissues stability around Straumann zygomatic abutments that have been achieved. This was also thanks to the anatomic, prosthetically driven position of the implants and the use of straight non- angulated abutments (Figs. 22-25). At one-year follow-up, the high level of patient satisfaction was maintained as she considered that all her expectations were fulfilled (Fig. 26). Acknowledgements The author particularly appreciated and acknowledge the contribution of Drs. Peter and Madalina Simon, ZAGA Center Stuttgart, Germany for the discussions during the prosthetic-driven implant planning phase and for taking care of the prosthesis manufacturing and placement. Fig.20. Occlusal post-surgery Occlusal post-operative view. Two flat design, apically threaded and body turned titanium surface, have been placed. Implant head are in a prosthetically driven position sealing the ZAGA “canal type” osteotomy. Fig.21. Occlusal sutured To maximize the amount of keratinized tissue buccal to the implant, a palatal incision was made. To make possible a first intention closure of the soft tissue, double pediculated partial flap was performed. Non resorbable mattress suture was used. Fig.22. One year-soft tissue, occlusal The one-year control shows the results of combining the use the ZAGA Concept for hard and soft tissue management and an implant design (Straumann Zygomatic implant ZAGA flat) with features adapted to the patient anatomy. Excellent bone and soft tissues stability around Straumann zygomatic abutments have been achieved. Fig.23. One year-prostheses, occlusal One-year occlusal view of the prostheses placed by Drs. Peter and Madalina Simon, ZAGA Center Stuttgart, Germany. Note the anatomic, prosthetically driven, position of the implants achieved with straight, non-angulated, abutments. Fig.24. UL post.23/6/2020 (1yr) CBCT oblique 2D cut and correspondent plane on 3D vision showing implant position and sinus status of the left implant at the one-year control. Totally transparency of the maxillary sinus is maintained. Fig.25. UR post.23/6/2020 (1yr) CBCT oblique 2D cut and correspondent plane on 3D vision showing implant position and sinus status of the right implant at the one-year control. Totally transparency of the maxillary sinus is maintained. Fig.26. Smiling. 23/6/2020 (1yr) Patient satisfaction is showed at one-year control Figure 21 Figure 23 Figure 25 Figure 20 Figure 22 Figure 24 Figure 26