Immediate Implant Placement in the Esthetic Zone Using a Novel Tapered Implant Design and a Digital Integrated Workflow: A Case Series.

The purpose of this case series was to assess the application of a novel self-cutting, tapered implant (Straumann® BLX, Institut Straumann AG, Basel, Switzerland) in combination with a digital integrated prosthetic workflow for the immediate placement and restoration. Fourteen consecutive patients, requiring replacement of a single hopeless maxillary or mandibular tooth, meeting the clinical and radiographic indication criteria for immediate implant placement, were treated. All cases followed the same digitally-guided procedure of extraction and immediate implant placement. Immediate temporization with full contoured screw-retained provisionals was performed using an integrated digital workflow. After implant placement and dual-zone bone and soft tissue augmentation, connecting geometries and emergence profiles were finalized. The average implant insertion torque was 53.2 ± 14.9 Ncm and ranged between 35 and 80 Ncm, allowing immediate provisional restoration in all cases. Final restorations were delivered three months after implant placement. An implant survival rate of 100% was observed at the 1-year recall after loading. The results of this case series suggest that immediate placement of novel tapered implants and immediate provisionalization using an integrated digital workflow can result in predictable functional and esthetic results for the immediate transition of failing single teeth in the esthetic area.

A new method of conclusively creating and transferring the emergence profile on single tooth immediate implant restorations: the E-merge protocol.

PURPOSE: The purpose of this article is to propose a new protocol for the accurate transfer of the peri-implant soft tissue emergence profile (EP) using a customized healing abutment or a provisional restoration whose shape is integrated into prosthetic design software. REPORT: The EP of the future restoration is created extraorally with an ideally shaped customized healing abutment or a provisional crown. Before insertion, the latter is screwed into a repositionable analog placed on a specially designed device and scanned with an intraoral scanner (IOS). This repositionable analog (Straumann RB Repositionable Implant Analog, Art. no. 065.0023), whose original purpose is to keep the correct orientation of the implant platform when placed in a printed model, is already available on the market. It is an exact replica of the implant with a corresponding external index. When scanned, it allows the digital transfer of the exact implant position and index. After healing, a full-mouth impression is made with an IOS without removing the customized healing abutment or provisional restoration. The STL files issued from both impressions are merged to produce a digital model used to design the final restoration, which can be inserted at the next appointment. CONCLUSION: The technique described is simple, predictable, and precise. It does not require a traditional implant level impression or the use of a digital accessory such as a scanbody to transfer the 3D implant position and the peri-implant gingival contour.

Evaluation of the Treatment of Partially Edentulous Patients With Bone Level Tapered Implants: 24-Month Clinical and Radiographic Follow-Up.

The aim of this case series was to assess, over a period of 24 months, the clinical and radiographic outcomes in partially edentulous patients receiving bone-level tapered implants. In total, 33 partially edentulous patients and 50 implants were evaluated. Patients received single or multiple implants in the posterior maxilla. Clinical and radiographic measurements of vertical bone levels were assessed at surgery, at loading, and 6, 12, and 24 months after surgery. The success and survival rates of the implants were also evaluated. Within the 24-month follow-up, only 1 implant failed (2.0%). Other biological or technical complications were not observed. The mean insertion torque was 34 ± 5.3 Ncm. Bone-level changes of 0.35 ± 0.23 mm were found between surgery and 12 months after surgery, and changes of 0.03 ± 0.05 mm were found between 12 months and 24 months after surgery. The overall change from surgery to 24 months after implant placement was 0.38 ± 0.24 mm. Most of the bone loss occurred between surgery and 3 months (0.28 ± 0.19 mm; P < .001); thereafter, the loss was minimal and statistically nonsignificant. Bone-level tapered implants yielded a high survival and success rate with minimal bone-level changes. Tapered implants could be considered as a predictable treatment option for partially edentulous patients with different types of bone qualities and loading protocols.

Strategic extraction protocol: Use of an image-fusion stereolithographic guide for immediate implant placement.

Increasingly, patients are demanding a smooth transition from a hopeless dentition to a fixed implant-supported prosthesis without the use of an interim removable denture. This raises new challenges in adapting computer-aided design and computer-aided manufacturing (CAD-CAM) techniques to patients whose treatment plan includes immediate implant placement in fresh extraction sockets. To facilitate this conversion to a rehabilitated dentition, a strategic extraction protocol (SEP) can be applied. The SEP consists of selecting strategic, remaining, hopeless teeth as abutments to stabilize an image-fusion stereolithographic guide and to allow the immediate placement of sufficient implants to support an immediately loaded fixed prosthesis. The remaining supporting teeth are extracted in the same surgical session before the placement of the interim prosthesis.

Mini-lateral windows for minimally invasive maxillary sinus augmentation: case series of a new technique.

OBJECTIVES: The purpose of this article was to introduce a new technique for minimally invasive lateral window sinus augmentation, developed to maximize the amount of residual lateral wall after the procedure. MATERIALS AND METHODS: Fourteen consecutive patients requiring maxillary sinus augmentation by a lateral approach and delayed implant placement were treated using standardized mini-lateral windows. Before the procedure, the remaining height of alveolar bone was determined; 6 months after the procedure, the augmented height and augmented width were measured. The extent of the antrostomy was calculated using a gauge and compared with a conventional window size. RESULTS: A total of 15 maxillary sinus augmentation procedures were performed in 14 patients using this technique. Every patient received the planned implant treatment 6 months after the sinus augmentation procedure. The average residual bone height was 2.1 ± 1.1 mm, the average augmented height was 13.4 ± 3.4 mm, and the average augmented width was 19.0 ± 5.5 mm. The average total area of the antrostomy was calculated to be 59.2 ± 12.8 mm. CONCLUSIONS: The results of this case series study suggest that this technique allows for the achievement of a similar result as with conventional size windows, but with a significantly smaller total window area.

Clinical investigation on axial versus tilted implants for immediate fixed rehabilitation of edentulous arches: preliminary results of a single cohort study.

PURPOSE: The purpose of this clinical investigation was to evaluate full-arch fixed-dental restorations supported by immediate loaded axial and tilted implants in a single-cohort study. Survival rate of axial and tilted implants was compared. MATERIALS AND METHODS: From 2006 to 2010, 30 patients were recruited and treated with dental implants. Provisional fixed-dental prostheses were screw-retained over axial or axial and tilted implants within 24 hours after surgery. Follow-ups at 6, 12, and 24 months and annually up to 5 years were scheduled, and radiographic evaluation of peri-implant bone level changes was conducted. RESULTS: Thirty patients (20 females and 10 males) were followed up for an average of 44 months (range 18-67 months). Six patients received both upper and lower implant rehabilitations, resulting in 36 restorations. A total of two hundred two implants were placed (maxilla = 118; mandible = 84) and 46% of the fixtures were evaluated at the 4-year recall. Four axial implants were lost in three patients, leading to 98.02% implant (97.56% axial implants and 100% tilted implants) and 100% prosthetic cumulative survival rate, respectively. No significant difference in marginal bone loss was found between tilted and axial implants in both jaws at 1-year evaluation. CONCLUSIONS: Midterm results confirmed that immediate loading of axial and tilted implants provides a viable treatment modality for the rehabilitation of edentulous arches.