Immediate loading can be a predictable and reliable treatment option using Straumann BLT dental implants

Mrs K J, a 50-year old female, presented with a missing upper right 1st premolar tooth which was extracted a few weeks before she was due to vertical crack within the tooth following a direct trauma to the area (Fig 1). The referring dentist had advised that the tooth was judged to be unrestorable and needed extraction. Mrs K J was referred to us for implant placement and restoration. However, alternative treatment options were discussed with the pros and cons of each option with her – removable denture, adhesive bridge, conventional bridge or dental implant.

Mrs K J was very keen on the dental implant option and so study models, wax up and surgical guide were prepared. A periapical radiograph with ball bearing was taken and utilised in planning the implant placement (Fig 2). A full dental examination revealed a stable dentition with no signs of dental or gum disease and a full medical history revealed no significant medical history and no known allergies. A letter detailing the treatment plan and associated risks were sent to the patient and one week before the implant placement operation, a consent form was signed discussing the possibility for immediate loading at the time of surgery. A temporary adhesive Rochette bridge was fitted using flowable composite. This adhesive bridge was also used as a communication tool with the lab and the patient who was happy with the shape and shade of this temporary adhesive bridge (Fig 3).

Eight weeks following the tooth removal, the patient presented for implant placement surgery. The female was given 2gm preoperative Amoxicillin 1 hour before surgery. A three-sided flap was raised and the upper right 1st premolar (UR4) osteotomy was prepared using Straumann drills and sequential drilling under copious irrigation. A 4.1 x10mm BLT implant (Straumann) was placed within the prosthetic envelope to crestal level and a primary stability with 45 Ncm insertion torque was achieved. (Fig 4 & 5) While we have maintained 1.5mm labial bone thickness, the implant apex perforated the apical part of the labial plate in order to achieve correct 3D implant placement and Cerabone and Jason membrane (Botiss) were used later on to cover the apical perforation and to create a labial convexity at the coronal one-third area.

A Straumann temporary abutment was adjusted and trimmed then fitted using 35Ncm torque. Teflon tape was used to protect the connection screw and then a small metal post was used to maintain the screw access channel. A temporary ready-made crown was adjusted and fitted on the metal temporary abutment using ProTemp (3M ESPE) material. Once it set hard, the metal rod and the Teflon were removed and the temporary crown was screwed out (Fig 6-13). Sub-gingival concavity and supra-gingival convexity were achieved during the temporary crown contouring process in order to achieve correct soft tissue conditioning using the temporary crown.(Fig 14-16) 4/0 Monocryl single threaded sutures (Ethicon) were used with vertical mattresses at the papillae area and sling suture around the temporary crown to achieve good gingival stability. Occlusion was checked and adjusted to allow 30microns clearance but no lateral interferences. The patient was very happy to walk home with a dental implant and an immediately loaded temporary crown at the UR4 area which was within her smile line. (Fig 17 & 18)

The implant was allowed to heal over 12 weeks during which the temporary crown was removed, re-contoured and polished at week number six, eight and 10 to achieve gradual soft tissue conditioning. (Fig 19) At the 12th week, the temporary crown was unscrewed and a well contoured peri-implant soft tissue was observed with the correct gingival emergence profile. (Fig 20) Open tray implant impression was taken using customised impression post (Fig 21). A screw-retained implant crown was constructed at the lab. The final screw-retained crown was fitted in place using the recommended 35Ncm torque, the cover screw was protected with a layer of isolation Teflon tape and flowable composite was used to cover the screw access channel. Occlusion was checked and post-operative oral hygiene instructions were given. (Fig 22-23)

 

More than a tapered implant

The market for dental implants is shifting towards shorter treatment times, improved efficiency and profitability. Now, with 50% of global implant sales being tapered*, the Straumann® Bone Level Tapered (BLT) Implant broadens the appeal of Straumann’s portfolio in line with both dentists’ and patients’ requirements.

The Straumann® BLT Implant is a significant step forward in setting a new standard within the field of tapered implants. Offering excellent primary stability in soft bone and fresh extraction sockets, the tapered form adequately compresses the underprepared osteotomy. It also enables clinicians to effectively master patients’ limited anatomy such as facial undercut, converging root tips, concave jaw structure or narrow atrophied ridges.

Building on the clinically proven features of the Straumann® BLT, Roxolid®, SLActive®, Bone Control Design™, CrossFit® connection and prosthetic diversity, Straumann® BLT Implants provide great peace of mind and the benefit of the new apically tapered design for excellent primary stability even in compromised bone situations.

*www.straumann.com/ar2014.html

For more information on the Straumann® Bone Level Implant call Straumann on  01293 651230 or visit one of their sites:

blt.straumann.com

straumann.co.uk

 

About the author

Dr Hassan Maghaireh

BDS, MFDS (Ed) MSc Implants (Manchester)

Clarendon Dental Spa, Leeds

GDC number: 84681

Dr Hassan MaghairehHassan Maghaireh is the head of the scientific committee at The British Academy of Implant & restorative Dentistry (BAIRD). He completed five years training in various maxillofacial units in the UK, gaining his membership in the Royal College of Surgeons in Edinburgh by Examination in May 2005. He then gained a Clinical Masters degree in Implant Dentistry from the University of Manchester winning the best clinical presentation award in 2008. Dr. Maghaireh maintains a private implant referral practice in Leeds, and has been involved with the University of Manchester as a Clinical Lecturer in Implantology on the University of Manchester MSc Program since 2007.

Hassan has a special interest in Evidence-Based Implant Dentistry, mainly with clinical perspective focusing on soft tissue management around aesthetic dental implants, bone grafting, immediate placement and loading and managing surgical and prosthetic complications in implant dentistry. He is actively involved in the oral health group of the Cochrane collaboration, updating evidence-based systematic reviews on various dental implants related topics. Hassan is on the editorial board for the European Journal of Oral Implantology where he has co-authored many random controlled trials on implant related issues.

Dr. Maghaireh is the regional ITI study club director for Leeds and is an accredited ITI speaker. He also acts as an official mentor the association of implant dentistry-UK (ADI), The British Academy of Implant & Restorative Dentistry (BAIRD) and various dental implants system in the U.K. Dr Maghaireh is the clinical director of the one-year Comprehensive Clinical & Evidence Based Dental Implantology courses in Leeds, Croatia, Bulgaria, Bahrain, Qatar, Kuwait, Emirates, Jordan and Iraq.

The dual nature of his clinical & evidence-based training makes Dr. Maghaireh a frequent author of dental literature, and a sought-after lecturer nationally and internationally.


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