Dental Asia May/June 2022

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USER REPORT Small diameter implants for single anterior edentulousness The limited bone volume often presented in anterior zones means that standarddiameter implants are not always possible. To avoid bone grafts, we use narrow implants that provide satisfactory results. By reviewing a few clinical cases, we will see how the use of small diameter implants to replace maxillary lateral incisors and mandibular incisors can be considerably simplified while providing results that are entirely satisfactory for the patient on an aesthetic and functional level. By Dr Richard Marcelat CLINICAL CASE 1: SMALL VESTIBULO- PALATINE BONE VOLUME A 42-year-old patient presented a bilateral agenesis of the maxillary lateral incisors (Fig. 1). The smile line analysis indicated a low smile line associated with toned lips. The oral examination showed small mesiodistal spaces in 12 and 22 as well as a rather thick gingival biotype. The patient’s reason for consultation was aesthetic. After discussing alternative solutions with the patient: orthodontic space closure, replacement with fixed dentures—bridge or crown, the patient ultimately chose implant-supported dentures. We worked in close collaboration with an orthodontist colleague, Dr Frédéric Chalas, who took responsibility for adapting the mesiodistal spaces which were required for the placement of the endosteal implants in positions 12 and 22. We saw the patient again after 14 months of orthodontic treatment (Figs. 2a–b), which consisted of wearing a multi-bracket appliance to open up the spaces at 12 and 22, while aligning the apices of adjacent teeth. Fig. 1 Fig. 2a Fig. 2b CT SCAN ANALYSIS AND CHOICE OF IMPLANTS The CT scan cross sections of 12 and 22 showed a limited bone volume on the Fig. 3a Fig. 3b Fig. 3c Fig. 3d Fig. 1: Baseline panoramic x-ray Figs. 2a–2b: End of orthodontic treatment Figs. 3a–d: CT scan cross sections showing the small exploitable volume on the vestibulo-palatine plane 44 DENTAL ASIA MAY / JUNE <strong>2022</strong>
USER REPORT vestibulo-palatine plane which would not allow standard diameter implants to be put in place without the use of a bone augmentation technique; the bone cortices were nevertheless preserved (Figs. 3a–d, 4). Narrow implants (Axiom 2.8 by Anthogyr) Fig. 4 were used for this restoration. Axiom 2.8 was designed exclusively to replace mandibular incisors or maxillary lateral incisors. It is equipped with a 3° Morse taper-type connection system with an integrated switching platform. The special feature of the system is the fact that the abutment is impacted without a transfixation screw. The false stumps are available in several gingival heights and angulation, which makes it adaptable for any prosthetic situation. Fig. 5a Fig. 5b Fig. 5c Fig. 5d PLACING THE IMPLANTS AND MAKING THE PROSTHESIS Placement of the implants in positions 12 and 22 was done during the same operation: Under local anaesthesia, two 2.8x10 implants were placed in a subcrestal position of 0.5mm (Figs. 5a–d). Very slight sub-drilling enabled bone condensation of the specific sites. The correct three-dimensional positioning of the implant was vital for the final aesthetic result. The delay period was managed by the use of temporary crowns stuck to the orthodontic archwire, left in place for the three months of osteointegration in order to ensure post-orthodontic fixation of the teeth. Three months post-surgery, the patient’s brackets were removed by the orthodontist and the temporary crowns made directly on Peek (polyether-etherketone) healing caps (Fig. 7). The basal surface of the temporary crowns was carefully polished. Fig. 6 Fig. 7 Fig. 8a Fig. 8b Fig. 9 Fig. 10 Fig. 4: 3D reconstruction of the CT scan cross sections of the premaxillary zone. The high concavity of the vestibular cortical plates can be noted in 12 and 22 Figs. 5a–d: Pre- and post-surgery x-rays of sites 12 and 22 Fig. 6: The impressions were made by Pop-in technique Fig. 7: The temporary crowns were made on Peek healing caps Figs. 8a–b: Master model with abutments Fig. 9: Ceramic and metal crowns on the master model Fig. 10: The crowns were sealed outside the mouth and the unit was impacted with the Safe Lock system After a period of two months of gingival maturation which was put to good use by carrying out dental bleaching in an outpatient setting, the prosthetic phase could begin. The implant impressions were made with the Pop-in technique (Fig. 6), with an individual impression tray made in the laboratory. The choice of the best adapted abutment by means of the planning kit by the laboratory was a vital step. In fact, the abutment tooth could only be very slightly retouched or not retouched at all. Having four gingival heights and four angulations enabled us to adapt to any clinical situation. The laboratory made the ceramic and metal crowns (Figs. 8a–b, 9). The dentures DENTAL ASIA MAY / JUNE <strong>2022</strong> 45
Page 1: www.dentalasia.net MAY / JUNE 2022
Page 4 and 5: CONTENTS TRENDS 22 Delivering tomor
Page 6 and 7: EDITOR’S NOTE Something different
Page 8 and 9: DENTAL UPDATES The Aspen Group and
Page 10 and 11: DENTAL UPDATES BioHorizons Camlog o
Page 12 and 13: DENTAL UPDATES DentalMonitoring unv
Page 14 and 15: DENTAL UPDATES Carestream Dental’
Page 16 and 17: DENTAL UPDATES ITI announces change
Page 18 and 19: DENTAL UPDATES uLab and People + Pr
Page 20 and 21: DENTAL UPDATES Penn Dental Medicine
Page 22 and 23: DENTAL UPDATES Retrace founder & CE
Page 24 and 25: TRENDS Delivering tomorrow’s dent
Page 26 and 27: DENTAL PROFILE The in-and-outs of t
Page 28 and 29: DENTAL PROFILE Communication and co
Page 30 and 31: DENTAL PROFILE What is your marketi
Page 32 and 33: CLINICAL FEATURE Preventing implant
Page 34 and 35: CLINICAL FEATURE may indicate the b
Page 36 and 37: CLINICAL FEATURE PBM Implant: Intra
Page 38 and 39: CLINICAL FEATURE Pharmacy, Tirgu Mu
Page 40 and 41: USER REPORT Becoming a digital prac
Page 42 and 43: USER REPORT Minimally invasive and
Page 44 and 45: USER REPORT BASE DENTINE 3M2 (70%)
Page 48 and 49: USER REPORT were verified in the mo
Page 50 and 51: USER REPORT Light management with Z
Page 52 and 53: BEHIND THE SCENES Validating 3D-pri
Page 54 and 55: BEHIND THE SCENES FIRST APPOINTMENT
Page 56 and 57: BEHIND THE SCENES Helping dental pr
Page 58 and 59: BEHIND THE SCENES What is the idea
Page 60 and 61: IN DEPTH WITH Renew smile and confi
Page 62: IN DEPTH WITH Neo edition of CS 820
Page 65 and 66: PRODUCT HIGHLIGHTS Align Technology
Page 67 and 68: PRODUCT HIGHLIGHTS Medit Medit laun
Page 69 and 70: PRODUCT HIGHLIGHTS W&H W&H celebrat
Page 71 and 72: SHOW PREVIEW The 5th Malaysia Inter
Page 73 and 74: EVENTS CALENDAR MAY 6 - 7 Mectron S
Page 76: VOCO's product FLOWABLE AND YET PAC

Dental Asia May/June 2022

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