Introduction

Dr Jochen K. Alius Introduction

 

Treatment schedule

  • Dr Jochen K. Alius 2The patient, a 62 year-old female, non-smoker, in good general systemic health, had multiple dental treatments.
  • The tooth 21 was failing endodontically and had a fractured post crown.
  • The patient wanted to replace this failing tooth with a fixed implant supported restoration.

Initial Situation

Dr Jochen K. Alius 3

  • The initial situation shows the periodontally affected tooth 21 which was restored with a metal-ceramic crown.

Initial X-ray

Dr Jochen K. Alius 4

  • Radiographically, the post in-situ shows gap between the root and pinned core. This is consistent with the clinical assessment of a crown-root fracture.

Planning

  • Various treatment options (+/-) were discussed.
    1. Tooth extrusion (post/core and crown)
    – Prolonged treatment
    + Good esthetics, tooth preservation
    2. Immediate implantation
    – Tooth loss
    + Good predictable prognosis, good long-term result
  • The patient opted for implant therapy. Since tooth 11 is tilted by periodontal inflammation slightly labially, a veneer was included in the planning.

Intraoral

  • Dr Jochen K. Alius 5After careful removal of the tooth crown, the initial suspicion of a crown-root fracture was confirmed.
  • The remaining root was removed with special consideration for the preservation of the buccal bone lamella.

Implant placement 1

  • Dr Jochen K. Alius 6The preparation of the implant bed was carried out under permanent contact of the drill to the palatal bone wall
    1.to avoid damaging the buccal bone lamella
    2. to ensure the implant position lies behind the esthetic border line.
  • The implant bed was underprepared at ∅2.8mm to accommodate a ∅4.1mm BLT implant. This is necessary in order to achieve a sufficient primary stability.

Implant placement 2

  • Dr Jochen K. Alius 7With the aid of the alignment pins and probe, the implant axis and position of the implant was checked in relation to the esthetic border line.

Implant placement 3

  • Dr Jochen K. Alius 8The implant was placed with the torque control device and sealed with a healing abutment.
  • The flap was closed with a 5/0 monofilament suture.

Implant placement 4

  • Dr Jochen K. Alius 9A post-operative radiograph was taken as a reference.

Final Restoration

  • Dr Jochen K. Alius 10 Clinical situation about 9 weeks after implantation.
  • The peri-implant papillae has slightly resorbed.

Final Restoration

  • Dr Jochen K. Alius 11After the fitting of the temporary abutment, the lab proceeds with scanning in the digital workflow.

Final Restoration

  • Dr Jochen K. Alius 12After the fitting of the temporary abutment, the lab proceeds with scanning in the digital workflow.
  • Dr Jochen K. Alius 13The dental technician digitally designed both the abutment and the framework of the final crown, using the Straumann® CARES X-Stream workflow
  • The single delivery of both components improves efficiency in the dental laboratory.

Final Restoration

  • Dr Jochen K. Alius 14The zirconium abutment is designed with a slight subgingival margin and the final zirconium crown is veneered

Final Restoration

  • Dr Jochen K. Alius 15The implant crown was inserted into tooth 21 and the veneer is bonded on tooth 11 on the same date.

X-ray – final

  • Dr Jochen K. Alius 16X-ray control after cementing the implant crown.

Final

  • Dr Jochen K. Alius 17Intraoral situation about 4 weeks after placement. It shows a harmonious gingival line under unattractive conditions.

Testimonial

  • Thanks to the new implant geometry I got the possibility to achieve better primary stability even in a difficult initial situation. This results in significantly improved results especially for immediate implantation cases with trans-gingival healing in the maxillary anterior region.

Tips and Tricks

  • Under-preparation of the implant bed is essential for good primary stability.

About the Author

Dr Jochen K. Alius 1Dr Jochen K. Alius,
Dr. med dent
Implantologist
Nuremberg, Germany

Graduations

  • 2007 DMD – The free jejunum transplant in the oral mucosae
  • 2010 Expert of Implantology DGOI
  • 2010 Diplomat of the ICOI
  • 2012 Master of Science in Oral Implantology DGI
Image(s) courtesy of Dr Jochen K. Alius, Germany
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