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logo 16 • the CAMLOG Partner Magazine • June 2017 logo 16 • the CAMLOG Partner Magazine • June 2017 12 13 CASE STUDY CASE STUDY thereafter at week 12 and 16 respectively. The final measurement indicated 73 ISQ which suggested good secondary stability. Prosthetic phase Four months after insertion, the patient presented for the prosthetic implant restoration with healthy soft and hard tissues (Fig. 12) . The healing cap was removed (Fig. 13) and a straight standard abutment was selected using the prosthetic planning set. The impression was taken with a post for the open tray impression technique and an individual tray (Figs. 14 and 15) . After fabricating the cast, the final zirconium oxide crown with an open screw access channel was prepared in the laboratory. Both the PEKK abutment as well as the zirconium dioxide crown were silanized for bonding the components. The crown and PEKK abutment were assembled using the dual-curing Multilink Implant (Ivoclar Vivadent) (Figs. 16 and 17) . The hybrid restoration was fixed on the implant in the mouth with a new abutment screw and a torque of 20 Ncm. The screw access channel was sealed with a sterile Teflon tape and a flow composite (Fig. 18) . The follow-up appointment six months after loading demonstrated a healthy and stable soft tissue situation (Fig. 19) . Discussion The use of zirconium dioxide implants is increasing. Even if they are less well documented than titanium implants, the reported results are promising [13]. The primary stability of an implant is an important factor for further loading. The use of resonance frequency analysis (RFA) for recording primary stability and its development is a well-documented method [14–16]. The stability of the CERALOG hexalobe implants from surgery to loading has been systematically reported in studies. The mean ISQ was 60.25 at insertion and 64 at loading in the maxilla [11]. The values obtained in the presented case, (63 at implantation and 73 at loading) are well in accordance with the study. Furthermore, a study comparing the primary stability of titanium and zirconium dioxide implants showed no statistically significant difference between the two systems [12]. Conclusion The zirconium dioxide CERALOG Hexalobe dental implant is a therapy of choice for single tooth replacement in the esthetic and non-esthetic region. According to the results obtained for measuring implant stability during the healing phase using resonance frequency analysis, loading is possible 12 weeks after implant insertion. Fig. 17: After try-in, the components were silanized and bonded together. Fig. 14: An impression post for the open impression technique was screwed in. Fig. 15: An impression was taken using a customized impression tray. Fig. 16: The PEKK abutment and the zirconium crown were delivered for the esthetic try-in. Fig. 18: The hybrid restoration was placed with a new abutment screw and a torque of 20 Ncm. Fig. 19: A healthy soft tissue situation presented six months after insertion of the restoration. Fig. 12: The control image shows the slight supracrestal placement of the two-piece implant. Fig 13: Healthy and stable soft tissue was present for impression taking of the situation. Fig 11: The implant stability quotient was measured using resonance frequency analysis. [1] Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983; 50: 399–410 [2] Brånemark PI. Einführung in die Osseointegration In: Brånemark PI, Zarb GA, AlbrektssonT, Hrsg. Gewebeintegriert- er Zahnersatz. Osseointegration in klinischer Zahnheilkunde. Berlin: Quintessenz Verlag, 1985 [3] Watzek G, Mailath-Pokorny G. Zahnärztliche Implantate. In: Schwenzer N, Ehrenfeld M, Hrsg. Zahnärztliche Chirurgie Band 3. Stuttgart, New York: Thieme Verlag, 2000: 127-144 [4] Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based on osseointegration : 50 years of progress, current trends and open questions. Periodontal 2000. 2017;73(1):7–12 [5] Spiekermann H. Implantologie. In: Rateitschak KH, Wolf HF, Publisher Farbatlanten der Zahnmedizin Vol. 10. Stuttgart: Thieme Verlag, 1994 [6] Taylor TD, Klotz MW, Lawton RA. Titanium tattooing associated with zirconia implant abutments: a clinical report of two cases. Int J Oral Maxillofac Implants. 2014;29(4):958–60 [7] Schultz-Mosgau S, Schliephake H, Radespiel-Tröger M, Neukam FW. Osseointegration of endodontic endosseous cones: zirconium oxide vs titanium. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(1):91–8 [8] Bächle M, Butz F, Hübner U, Bakalinis E, Kohal RJ. Behavior of CAL72 osteoblast-like cells cultured on zirconia ceramics with different surface topographies. Clin Oral Implants Res. 2007:18(1)53–9 [9] Koch FP, Wenig D, Krämer S, Biesterfeld S, Jahn-imercacher A, Wagner W. Osseointegration of one-piece zirconia implants compared with a titanium implant of identical design: a histomorphometric study in the dog. Clin Oral Implants Res. 2010;21(3):350–6 [10] Depprich R, Zipprich H, Ommerborn M, Mahn E, Lammers L, Handschel J, Naujoks C, Wiesmann HP, Kübler NR, Meyer U. Osseointegration of zirconia implants: an SEM observation of the bone-implant interface. Head Face Med. 2008;4–25 [11] Kokovic V, Rahman MM, Rahman B, Tattan M. Assessment of implant stability of two-piece zirconium dioxide implants using the resonance frequency analysis: A pilot study. Int J Experiment Dent Sci 2015;4(2):87–94 [12] Tattan M, Kokovic V. Titanium or Zirconia? Clinical assess- ment of primary implant stability. 8th Dental-Facial Cosmetic Int’l Conference 2016, Dubai UAE [13] Pieralli S, Kohal RJ, Jung RE, Vach K, Spies BC. Clinical outcomes of zirconia dental implants A systematic review J Dent Res. 2017;96(1): 368–46 [14] Balleri P, Cozzolino A, Ghelli L, Momicchioli G, Varriale A. Stability measurement of osseointegrated implants using Osstell in partially edentulous jaws after 1 year of loading: a pilot study. Clin Implant Dent related Res 2002;4(3):128–32 [15] Kokovic V, Vasovic M, Shafi E. Assessment of primary implant stability of self-taping implants using resonance frequency analysis. Saudie J Dent Scien 2014;6:35–49 [16] Kokovic V, Jung R, Feloutzie A, Vladmir T, Juriscic M, Hämmerle CHF. Immediate vs. early loading of SLA implants in the posterior mandible: 5-year results of randomized controlled clinical trial. Clin Oral Implants Res. 2012;25(2):1–6 LITERATURE AUTHOR Vladimir Kokovic, DDS, M. Sc, PhD Dr. Vladimir Kokovic is working as oral surgeon in the private medical center in Shrajah, United Arab Emirates. He is also part-time pro- fessor at the Maktoum Bin Hamdan Dental University, Dubai and lecturer in few certificate programs for oral implantology. He completed his studies in oral surgery, Master of Science in Oral Surgery and PhD in Oral Implant Dentistry at the University of Belgrade, Serbia. He was ITI lecturer at the University of Zurich, Switzerland. In 2007, he was elected to ITI Fellow, since 2012 he is a Member of the Serbian Innovation Academy, and since 2016, the Academic of the European Science Academy. Dr. Kokovic is author of two bone grafting patents, one monographic, 26 original articles and six research projects. Contact details Dr. Vladimir Kokovic, DDS, M. Sc, PhD Advance Europe Medical Centre LLC. Al Kaloti Tower, Al Majaz 2, Shrajah UAE Phone: +971 6 5574480 / +971 55 1536346 aemcuae@gmail.com