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Buccal bone wall protection on a maxillary bicuspid

Buccal bone wall protection on a maxillary bicuspid

The width of the buccal wall of a dental implant is becoming more and more important for its long term durability.
Placing the dental implant with 1,5 to 2 milimeters away from the buccal wall provides the bone wall with enough blood supply.

3,75x12,5" ICX-Templant internal hexagon under bone-level concavity buccal bone wallBio-Oss Bio-Guide GBR material buccal bone wall

Opposite to teeth, whose surrounding bone receives plenty of blood support from the periodontal ligament, the implant have no ligament and no surrounding blood circulation. Thus the buccal wall blood support comes only from the periosteum and the transeptal blood vessels.

Providing the buccal bone wall with a good thickness allows the internal bone blood vessels to supply nutrients to the buccal bone.

  • Diagnosis:
The X-ray shows two edentulous spaces on a 60 year-old man, non-smoker. Thick biotype.

occlusal view, upper jawPanoramic diagnostic X-ray implant surgeryocclusal view, lower jaw
 
Lateral right view, pre-operatoryFront view, preo-operatoryLateral left view, pre-operatory dental implant surgery
 
 
Preoperatory diagnostic measures. Control of the soft tissue quantity and quality
lateral right, invagination soft tissue attached gingivaocclusal right showing invagination soft tissue, mirror view

as well as a2D X-ray measurement with 5″ balls.
 
Panoramic diagnostic X-ray measurement balls dental implant surgery
  • Implant placement surgery

Regular split flap with two vertical discharges mesial and distal of the spot. Bone condensing carried out to finally place a 3,75×12,5″ ICX-Templant (internal hexagon) insertion after bone spreading.
The implant is placed 1mm under the bone level. This allows some typical crestal bone resorption while still keeping the internal cone properties of the implant. Notice the concavity of the buccal wall under the ridge level.

Bio-Oss Bio-Guide GBR buccal bone wall3,75x12,53,75x12,5" ICX-Templant internal hexagon under bone-level concavity buccal bone wall
Bio-Oss and Bio-Guide GBR material protecting the buccal bone wall. This increases the initial volume and adds extra hard tissue substance to the buccal wall.
 
 
Panoramic post-operatory X-ray 3,75x12,5" ICX-Templant implants
Panoramic post-operatory X-ray, after placing two 3,75×12,5″ ICX-Templant internal hexagon dental implants.
 
 
Suture with 4/0 Prolene.
 
4/0 suture wund4/0 suture wund
 
and healing sequence after 2, 5 and 9 weeks
2 weeks, implant surgery wund healing

9 weeks, implant exposure  surgery wund healed, lateral right view40 days, implant surgery wund healing, occlusal mirror view9 weeks, implant surgery wund healed, occlusal mirror view

 

  • Implant exposure surgery after 9 weeks

a regular exposure surgery, with a minimal incision from the palatinal side, and the tissue buccally displaced. Healing abutment over a 3,75×12,5″ ICX-Templant (internal hexagon)

implant exposure surgery, tissue buccally displaced. Healing abutment 3,75x12,5" ICX-Templant (internal hexagon)implant exposure surgery, tissue buccally displaced healing abutment 3,75x12,5" ICX-Templant (internal hexagon)

3 weeks after the exposure surgery, with the healing abutment.

3 week inplant exposure surgery healing abutment over the 3,75x12,5" ICX-Templant (internal hexagon)3 week implant exposure surgery healing abutment 3,75x12,5" ICX-Templant (internal hexagon)
  • Prosthetical phase

Impression transfer for a closed tray.

 
Impression transfer abutment 3 week 3,75x12,5" ICX-Templant (internal hexagon)
3,75×12,5″ ICX-Templant (internal hexagon) abutment on cast lab modell showing the platform switch, with the corresponding crown
 
3,75x12,5" ICX-Templant (internal hexagon) abutment cast lab modell platform switch3,75x12,5" ICX-Templant (internal hexagon) abutment crown3,75x12,5" ICX-Templant (internal hexagon) abutment cast lab modell platform switch, crown
 
3,75×12,5″ ICX-Templant (internal hexagon) abutment emerging. Screwed at 30Ncm torque.

3,75x12,5" ICX-Templant (internal hexagon) abutment 3,75x12,5" ICX-Templant (internal hexagon) abutment occlusal mirror view
  • Crown insertion
Metal-ceramic crown placed on the 3,75×12,5″ ICX-Templant (internal hexagon) abutment. Notice the metal line at the gum level, due to slight gingival retraction
 
Metal-ceramic crown implant 3,75x12,5" ICX-Templant (internal hexagon) abutment. metal line gum level  gingival retractionICX-Templant (internal hexagon) abutment. metal line gum level  gingival retraction
 
 
7 weeks after insertion. The metal-ceramic crown placed on the 3,75×12,5″ ICX-Templant (internal hexagon) abutment. Notice that the metal line at the gum level has dissapeared, due to gingival re-growth
 
ICX-Templant (internal hexagon) abutment. metal line gum level  gingival retractionICX-Templant (internal hexagon) abutment. metal line gum level  gingival retraction
 
occlusal mirror view of the final result
3,75x12,5" ICX-Templant internal hexagon3,75x12,5" ICX-Templant internal hexagon ceramic crown
 
 
 
 
 
 
 
 
Buccal bone wall protection on a mandibulary molar

Buccal bone wall protection on a mandibulary molar

Opposite to teeth, whose surrounding bone receives plenty of blood support from the periodontal ligament, the implant have no ligament and no surrounding blood circulation. Thus the buccal wall blood support comes only from the periosteum and the transeptal blood vessels.
Providing the buccal bone wall with a good thickness allows the internal bone blood vessels to supply nutrients to the buccal bone.
bone cavity ICX-Templant internal hexagon bone level dental implant
protecting the buccal bone wall
Bone graft autologous bone Bio-Oss buccal wall
with bone graft and membrane

The width of the buccal wall of a dental implant is becoming more and more important for its long term durability.
Placing the dental implant with 1,5 to 2 milimeters away from the buccal wall provides the bone wall with enough blood supply.
 
  • Diagnosis:
The X-ray shows two edentulous spaces on a 60 year-old man, non-smoker. Thick biotype.
occlusal view, upper jawPanoramic diagnostic X-ray implant surgeryocclusal view, lower jaw
Lateral right view, pre-operatory dental implant surgeryFront view, preo-operatory dental implant surgeryLateral left view, pre-operatory dental implant surgery

Preoperatory diagnostic measures. Control of the soft tissue quantity and quality

pre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgery

pre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgerypre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgery

pre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgerypre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgery
as well as a2D X-ray measurement with 5″ diameter balls.
Panoramic diagnostic X-ray measurement balls dental implant surgery
  • Implant placement surgery
Regular split flap with only one vertical discharge mesial of the spot. 
The 3,75×12,5″ ICX-Templant (internal hexagon) dental implant is placed 1mm under the bone level. This allows some typical crestal bone resorption while still keeping the internal cone properties of the implant. Notice the concavity of the buccal wall under the ridge level.
 
bone cavity ICX-Templant internal hexagon bone level dental implant
Bio-Oss and Bio-Guide GBR material protecting the buccal bone wall. This increases the initial volume and adds extra hard tissue substance to the buccal wall.
Bone graft autologous bone Bio-Oss buccal wallBio-Guide collagen membrane bone graft autologous bone Bio-Oss dental implant
Panoramic post-operatory X-ray, after placing two 3,75×12,5″ ICX-Templant internal hexagon dental implants.
Panoramic post-operatory X-ray 3,75x12,5" ICX-Templant implants
Suture of the flap with 4/0 Prolene.
Suture 4/0 prolene
healing sequence after 2 weeks,
Healing phase 2 weeks implant surgery
and after and 9 weeks
soft tissue implant surgery lateral volume increase

soft tissue implant surgery lateral volume increase

  • Implant exposure surgery 
after 8 weeks a partial thickness displacement flap is moved buccally, with the incision beginning well on the lingual side, The keratinized tissue is displaced buccally. 6″ Healing abutment over the 3,75×12,5″ ICX-Templant (internal hexagon)
 
Implant exposure surgery. Buccally displacement flap increase attached gingiva buccal wallImplant exposure surgery. Buccally displacement flap increase attached gingiva buccal wallImplant exposure surgery. Buccally displacement flap increase attached gingiva buccal wall
3 weeks after the exposure surgery, with the healing abutment.
 
Implant exposure surgery. Buccally displacement flap increase attached gingiva buccal wall
  • Prosthetical phase

Impression transfer for a closed tray.

Implant exposure surgery. Buccally displacement flap increase attached gingiva buccal wall impression abutment
 
3,75×12,5″ ICX-Templant (internal hexagon) abutment on cast lab model showing the platform switch, with the corresponding crown
 
Cast model platform swtiching abutmet ICX-Templant 3,75" analogCast model platform swtiching ICX-Templant 3,75" analog
Cast model platform swtiching abutment ICX-Templant 3,75" analog crownCast model platform swtiching abutment ICX-Templatnt 3,75" analog
Soft tissue 6 weeks after the implant exposure surgery. 6″ healing abutment.
 
Soft tissue implant exposure surgery healing abutment ICX-Templant 3,75"Soft tissue implant exposure surgery healing abutment ICX-Templant 3,75"
3,75×12,5″ ICX-Templant (internal hexagon) abutment emerging. Screwed at 30Ncm torque.
Soft tissue implant exposure surgery healing abutment ICX-Templant 3,75"
  • Crown insertion
Metal-ceramic crown placed on the 3,75×12,5″ ICX-Templant (internal hexagon) abutment. Notice the metal line at the gum level, due to slight gingival retraction
Soft tissue implant exposure surgery crown abutment ICX-Templant 3,75"
Soft tissue 12 weeks after the implant exposure surgery, 6 weeks after crown placement.
Soft tissue implant exposure surgery healing crown abutment ICX-Templant 3,75"Soft tissue implant exposure surgery healing crown abutment ICX-Templant 3,75"Soft tissue implant exposure surgery healing crown abutment ICX-Templant 3,75"
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Ball implants vs Locator attachments as effective solutions for an unstable overdenture prosthesis

Ball implants vs Locator attachments as effective solutions for an unstable overdenture prosthesis

Implants with ball retainers an Locator attachments on the lower jaw are an efficient solution to avoid the instability of a total prosthesis, especially for those patients with a big tongue (macroglosia) and little bone ridge retention.


Actually, the tongue tends to grow as we grow old, and even more when we lose teeth, because the leave more place for the tongue itself.
With the tongue movements, the prosthesis comes loose easily and that is usually uncomfortable for the patients because of the lack of confidence on the prosthesis while eating or speaking.

The lower jaw keeps normally enough bone on the anterior region, even in very atrophic cases. This case, from a 77 year-old male, shows more than enough bone kept. So 3 ICX implants, all three 15” x 3,75” were easily set on the most conveniet places of the lower anterior region.

The remainig lower left wisdom tooth was left in place. At 77 years of age and without sympoms and no influence on the therapie, it can as well stay in place.

So, after two months the healing caps are changed by ball retainers and the old prosthesis is relined in order to fit the new conectors.

The prosthesis is marked below, exactly where the contact points are.

Then comes the drilling until the prosthesis rests freeely on the gums.

Reline resin is added under the prosthesis. The patient bites in the normal position and the resin selfcures in the mouth.

The rubber rings inside the stainless steel structure can be chosen in three differente degrees of hardness and retention. They wear out like every rubber component and can be therefore easily changed.

After a few minutes cure time the retainers are already fixed and the retaining force can already be appreciated, as the prosthesis stays in the right position although the tongue and the cheeks exert the same force as before.
In this case, the three ball retainers proved not to be retentive enough for the patient. Normally a four implant solution provides a more retentive, more stable, four-point trapezoidal support. Nut the patient was running on a low budget and we had to go for a three implant display, with the central implant close to the mandibular synfisis. 
By changing the three ball retainers into Locator attachments and just placing the softer plastic rings under the metal matrixes, we achieved a good degree of confort for the patient.
Bone regeneration around the neck threads of an ICX implant

Bone regeneration around the neck threads of an ICX implant

In this post I want to show the bone regenerating effect from the narrow threads around the neck of an implant, brand ICX, 8” long, 4,8” wide. You can see the one-year evolution control on this following post

Day O: a second molar on the left upper jaw was extracted on May 9, 2011 due to a tooth fracture. The X-ray was taken after the extraction. The wisdom tooth is kept behind to minimite the alveolar resortion.
Three months later, on August 16, 2001 the ICX 4,8″x8″ was set with 35 N primary stability, by means of a punch technique and small vertical sinuslift, using a collagen membrane and autogenous bone. The implant was set further distal to the center space, counting already on the future extraction. The wund is sealed with a platform-switch healing screw.
 
Two months later, on October 18, 2011, I make another X-ray check, test the stability of the implant.The bone has grown around the narrow neck threads. The bone is condensed around the apex and the impact sound is excellent, showing a good integration.
I insert the closed-impression post. Now has come the moment of the extraction of the third molar (wisdom tooth), because it is no longer necessary and, furthermore, interferes with the plastic cap that goes over the post. The impression is taken therefore after the extraction.
 
 
Nine days later, on October 27, 2011, the abutment is screwed in with 35 N torque and the crown is cemented with temporary cement until the 6-moth control.
* To see the  the one-year evolution control go this post

 

Maxillary bicuspids on both sides. Esthetic treatment with four implants.

Maxillary bicuspids on both sides. Esthetic treatment with four implants.

This is a simple case with plenty of bone, plenty of attached gingiva and quite good prosthetic space. So we might as well expect some esthetic results.

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However, it’s interesting to notice the difference in healing following the two different techniques chosen while stitching the flaps back in place.

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On the right side I simply faced both parts of the wound and sewed them up with simple and double stitches. The picture sequence is as of 0, 5 and 22 day period.

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On the left side I removed part of the gum prior to sewing both ends in place, letting the screws exposed. The healing, as we can see, is apparently healthier, no second surgery was needed to expose the healing screws, but the final result was the same on both sides. Basically, because the attached gingiva was generous on both, the gum biotype was thick and there was no need to lift up the flaps during surgery, as the bone was wide enough, too.
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These are the radiographic details. External hexagon 3.75 x13 and 10mm, . Front implant overlapped radiographically due to the pantomographic angle of exposure.

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Prosthetic phase
All except for the stump on 24, are screwed. 24 was done on stump because the intermaxillary gap was short. The antagonist 35 was also reduced in height, as you may see. When the occlusion is so well defined, I take partial casts, as they are more comfortable to obtain.
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The three screw chimneys are filled up with glass ionomer cement for this final result
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I placed an overnight acrylic splint to prevent bruxism, too.
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