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26/02/2021

Dento-alveolar rehabilitation with Arcsys implant and Nanosynt bone graft

Authors: Dr. Jéferson Fagundes

Patient gender and age: Female patient, 67 y.o.

Chief complaint: Absence of tooth 12 and aesthetic dissatisfaction

Initial evaluation: After anamnesis, clinical and tomographic examination, a thin alveolar bone structure was observed in the region of element 12 and volume loss of soft tissue, indicating tissue reconstruction associated with implant installation.

Treatment performed

A 3.3x9 Arcsys implant was installed in the region of the element 12, with a torque obtained of 50Ncm. After the implant was installed, a vestibular bone wall fenestration was observed (which was expected, due to the thin bone wall). Soon after, the angular referrer was attached to the implant to personalize the angle of the 3x6x2.5 Arcsys sleeve. After customizing the trunnion to the Arcsys angulator in 6 degrees, the prosthetic component was installed on the implant with the hammer. Then, the autogenous conjunctive graft and the Nanosynt bone graft were applied to the buccal bone wall and protected by an absorbable collagen membrane. The provisional crown was made directly on the multifunctional peek transfer with flow resin. The surgery was completed using PTFE sutures. After 120 days, definitive restorative procedures were initiated, by making ceramic zirconia / feldspathic crowns on teeth and on the implant 12.

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FIG. 1 - Initial aspect

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FIG. 2 - Initial tomographic section

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FIG. 3 - Initial lateral aspect

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FIG. 4 - Incisal initial aspect

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FIG. 5 - 3,3 x 9 Arcsys implant

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FIG. 6 - Implant installed 2mm infra-bone

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FIG. 7- Incisal view of the implant

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FIG. 8- Angle referrer coupled

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FIG. 9- Angulation determined for the abutment

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FIG. 10- Angulation customized in 6 degrees

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FIG. 11- Abutment installed and Bone graft

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FIG. 12- Nanosynt bone graft

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FIG. 13- Collagen membrane placed

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FIG. 14- Multifunctional transfer over the abutment

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FIG. 15- Provisional crown installed

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FIG. 16 - Surgery completed

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FIG. 17- Lateral postoperative appearance

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FIG. 18 - Panoramic image after 30 days

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FIG. 19- Clinical aspect after 90 days

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FIG. 20- Digital prosthetic planning

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FIG. 21- Ceramic crowns on the model

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FIG. 22- Cemented crowns: case completed

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FIG. 23 - Lateral view: case completed

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FIG. 24 - Zoomed image element 12

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FIG. 25 - Before/After: lateral view

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FIG. 26 - Before/After: frontal view