Choosing a combination of dental implants and drilling procedures that suits bone conditions at the implant site: a clinical presentation
Sept. 27, 2011
By Pär-Olov Östman, DDS, PhDAlthough high success rates have been reported for implants placed with immediate-loading procedures, this approach places high demands on clinicians. Experienced surgeons can obtain the best primary stability and clinical results by choosing a combination of implants and drilling procedures that suits the bone conditions at the implant sites. OSSEOTITE® 2 Certain® Implants (BIOMET 3i, Palm Beach Gardens, Fla.) were recently introduced to help surgeons meet this goal. These implants are manufactured from commercially pure titanium and are dual-acid-etched (DAE) to impart the OSSEOTITE Surface from the apex to the top of the collar. The OSSEOTITE Surface is characterized by one- to three-micron peak-to-peak irregularities. This complex micron-scale topography has been theorized to aid in blood-clot retention, platelet activation, and de novo bone interdigitation. Like Full OSSEOTITE Implants (FOSS), the OSSEOTITE 2 Implants have the etched surface all the way to the top of the implant. An altered micro-texture in the coronal part of an implant might have a bone-preserving effect on the coronal bone bed.Case presentationThe following clinical case presentation demonstrates placement of OSSEOTITE 2 Certain Implants used in the treatment of a 57-year-old female patient who presented with several recently extracted and missing teeth in the maxilla. She desired fixed restorations. The treatment plan accepted by the patient included implant placement and immediate provisional restoration of multiple implants. The treatment rendered for the maxillary left posterior quadrant is shown in this case presentation.A midcrestal incision was made (Fig. 1), and the soft-tissue flaps were reflected to expose the residual ridge. A starter drill was used first to begin preparation of the osteotomies (Fig. 2). Preparation of the osteotomies continued with use of a 2 mm diameter twist drill (Fig. 3), followed by use of a 3 mm diameter twist drill (Fig. 4). The quality of the residual alveolar bone in the maxillary left posterior quadrant was deemed Type IV (soft) and, therefore, a clinical decision was made to undersize the osteotomies. The final drill diameter was 3.85 mm. Two 5.0 mm diameter OSSEOTITE 2 Certain Implants were placed into the prepared osteotomies in tooth sites Nos. 12 and 14 (Figs. 5 through 7). An OSSTELL ISQ (Osstell AB, Gothenburg, Sweden) was placed to measure the ISQ value of the implants to determine primary stability (Fig. 8).
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Fig. 84 mm diameter Low Profile Abutments (BIOMET 3i) were chosen for the 5 mm diameter implants to provide for platform switching. The abutments were placed into the internal interface of the implants using the ASYST® Abutment Placement Tool (Fig. 9). The Low Profile Abutments were tightened to 20 Ncm using a Standard Abutment Driver Tip and a torque device (Fig. 10). QuickBridge® Titanium Temporary Cylinders (BIOMET 3i) were placed onto the abutments (Fig. 11), followed by the placement of QuickBridge Caps (PEEK) (Figs. 12 and 13). A vacuum-formed template made presurgically was filled with self-curing composite resin and inserted over the Abutment/Temporary Cylinder/QuickBridge Caps complex. Once the material set, per the manufacturer’s instructions, the template was removed, followed by the provisional restoration. The QuickBridge Caps were picked up in the provisional restoration. The provisional restoration was trimmed and polished and reseated intraorally.
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Fig. 13Two months after implant placement and immediate provisionalization, the patient returned for impressions and fabrication of the definitive restoration. The provisional restoration was removed revealing healthy soft tissue surrounding the Low Profile Abutments (Fig. 14). Impressions were made of the abutments, and a three-unit BellaTek™ Copy Mill Framework/Porcelain restoration was fabricated (Fig. 15). Periapical radiographs were taken (Fig. 16), demonstrating good preservation of the crestal bone due to platform switching (4 mm diameter abutments on the 5 mm diameter implant restorative seating surfaces). The patient was given oral hygiene instructions and released.
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Fig. 16Pär-Olov Östman, DDS, PhD, received his dental degree from the University of Umeå, Sweden. He received his PhD degree in the Department of Biomaterials, Institute for Surgical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. He is head of the “Team Holmgatan” private practice clinic in Falun, Sweden, and assistant professor in the Department of Biomaterials, Institute for Surgical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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