Partner Magazine logo 16

logo 16 • the CAMLOG Partner Magazine • June 2017 logo 16 • the CAMLOG Partner Magazine • June 2017 10 11 CASE STUDY CASE STUDY Dr. Vladimir Kokovic, DDS, M. Sc, PhD, Shrajah, UAE CERALOG – THE FULL CERAMIC SOLUTION FROM CAMLOG ESTHETIC PREDICTABLE RESTORATION OPTION FOR A MAXILLARY PREMOLAR Fig. 1: This view shows the clinical initial situation from the occlusal aspect. In the 1970s, titanium implants made their breakthrough in enossal implant dentistry. Intensive basic research by a working group led by Per-Ingvar Brånemark resulted in the chance discovery of a high tolerance for titanium in human bone tissue. This phenomenon was referred to as osseointegration. The demand for a careful, atraumatic, and “sterile” surgical technique with standardized drilling instruments [1–2] was followed by the development of a pure titanium screw with prosthetic connecting elements. Even today, some 50 years after Brånemark’s first conclusive studies and a rapid development of a variety of systems, his insights into implant dentistry are just as valid as ever [3–4]. Following a statement issued by the DGZMK in 1998, implant dentistry was also established as a recognized therapeutic measure [5]. The scope of indications has become virtually limitless due to the development of new, complex, surgical and prosthetic methods. This has led to increased expectations with regard to functionality, esthetics, and long-term success and inevitably to new materials, such as the “white” zirconium dioxide. Titanium dental implants no longer need to prove their osseointegration and long- term success anymore. However, in thin biotypes, titanium implants might leave a grayish shadow. As a result, a few cases of titanium tattooing have been reported for the use of zirconium oxide abutments on titanium implants [6]. This can be a con- cern for demanding patients. Furthermore, there are members of the public who re- quest metal-free implants since it has been postulated that titanium allergy can occur. In both cases, ceramic implants might be considered the material of choice. Some advantages of zirconia implants have been widely described in the literature. Zirconi- um dioxide implants are reported to allow excellent cellular proliferation [7–8] and have a bone-implant contact comparable to that of titanium implants [9–10]. The primary stability of zirconium dioxide im- plants is comparable to that of titanium implants [11–12]. Good planning between practitioner, dental technician, and patient is the key to success. Information about the patient and the treatment A 32-year-old male patient reported to our medical center whose first premolar in the second quadrant had been extracted eighteen months before due to a vertical root fracture. The patient did not have any medical history that contraindicated the placement of an implant and he requested a metal-free implant. The extraoral clinical examination revealed a symmetry of the face. On laughing, the lip completely covered the transition from the anterior teeth to the gums. Intraoral examination revealed a healthy mucosa in regio 24 and around the adja- cent teeth. The adjacent teeth and antag- onists were healthy and firmly anchored in the bone. Both the height and width of the alveolar ridge were adequate for inserting implants. The inter-occlusal distance for reconstruction was 5 mm, and a bilateral canine guided occlusion and class I molar relationship was observed (Figs. 1 and 2) . Following radiographic analysis of the edentulous region, the decision was made to use an 8 mm long two-piece CERLAOG ® Hexalobe implant with a 4 mm diameter. (CERALOG ® Hexalobe implant, CAMLOG Biotechnologies AG, Basle, Switzerland). Implant placement One hour before the implant placement procedure, the patient took an antimicrobial prophylaxis (Amoxicillin ® 2 g) and rinsed his mouth for ten minutes with a chlorhexidine digluconate solution (0.2%) prior to the procedure. The implant placement was carried out under local anesthesia with 2% epinephrine (Xilestesin ® ; Espe Dental AG, Seefeld, Germany). After crestal incision and elevation of the flap, the implant bed was prepared in accordance with the company’s surgical guideline (Figs. 3–8) . The Implant site was marked with a round bur (Ø 1.4 mm) and a point drill (Ø 1.5 mm) with a maximum speed of 800 rpm (Figs. 3 and 4) . The pilot drill (Ø 2.4 mm) was used for the first step of the preparation of the implant bed to the final depth (Fig. 5) . The directional gauge was used to control the depth of the bed and the implant orientation. The S-drill (Ø 2.9 mm – yellow ring) and the M-drill (Ø 3.4 mm – red ring) were each used for the final preparation of the implant bed with a maximum speed of 500 rpm (Figs. 6 and 7) . Definitive assessment of site depth and implant angulationwas performed using the depth gauge M. The implant thread was precut (Ø 4.0 mm tap) to optimize torque resistance during insertion (Fig. 8) . The implant was removed from the blister using the implant holder (Fig. 9) and inserted into its final position in the implant bed site with a maximum torque of 35 Ncm and speed of 15 rpm. After placing the healing cap, the mucosal flap was adapted saliva-proof with single button sutures (Fig. 10) . Immediately after insertion, primary implant stability was measured using Resonance Frequency Analysis (Osstell Integration Diagnostics, Goteborg, Sweden). To this purpose, a SmartPeg™ was attached to the implant. The values of the implant stability quotient (ISQ) obtained showed an adequate primary stability (63 ISQ) (Fig. 11) . During the healing phase, implant stability was measured on a weekly basis up to the eighth week and Fig. 2: The occlusal distance from lateral is reduced considerably by the elongated premolar. Fig. 3: The implant position is marked using the Ø 1.4 mm round bur. Fig. 4: The marking of the implant bed is deepened using the triangular point drill. Fig. 5: Pilot drilling to the exact implant length was performed using the Ø 2.4 mm pilot drill. Fig. 6: The drilling channel is widened using the S form drill Ø 2.9 mm. Fig 7: Expansion of the implant bed to 3.4 mm is performed with the M form drill. Fig. 8: The thread was tapped (Ø 4.0 mm) to optimize the torque resistance for insertion of the implant. Fig 9: To insert the CERALOG Hexalobe implant, the insertion tool is pressed into the inner connection and the implant placed in situ. Fig. 10: Healing of the CERALOG Hexalobe implant was transgingival. To do this, a healing cap was placed and the mucoperiostal flap was adapted with single button sutures.