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11/03/2022

Immediate implant, clinical convenience and patient comfort

Author: Dr. Everton Salante and Dr. Polyane Mazucatto Queiroz

MAIN COMPLAINT: Mobility in element 22.

INTRODUCTION

A 57-year-old female patient complained of mobility in element 22. The clinical and radiographic evaluations showed root fracture with poor prognosis for the maintenance of the element in the mouth. It was proposed to replace the compromised dental element with an immediate implant with immediate load, provided that it achieved considerable primary locking.

Thus, the initial planning provided for the installation of an Arcsys implant (3.3 x 11 mm) immediately after the removal of the remaining root, receiving onto it a prosthetic component (3 x 6 x 2.5 mm).

After minimally invasive exodontia, the implant was installed 4 mm in relation to the gingival zenith and 2 mm infraosseous, where it was locked with 60 N.cm torque. An abutment for cement-retained restoration 3 x 6 x 2.5 mm was installed. After its activation, the gap was filled with Nanosynt, and the provisional was prepared using the PEEK multifunctional transferer, easily performed with a veneer of stock tooth. One of the greatest advantages of this stage was the obliteration of the alveolar embouchure with concomitant tissue conditioning, initiating the personalization of the emergence profile right away.

After the perfect healing of the tissue, the transfer molding was carried out with the personalization of the transferer, using light-curing acrylic composite for a copy of the emergence profile. This achieved a perfect adaptation and maintenance of the emergence profile, facilitating single-step transfer molding. The transferer was captured by the molding and sent to the laboratory to manufacture the prosthetic piece.

The prosthetic crown received from the laboratory is quickly cemented on an analog of the component used, in order to allow excess cement to be removed, and then taken to the patient's mouth, positioned on the stainless steel component. Thus, the possibility of excesses being allocated around the peri-implant tissue is reduced.

001   Radiografia Panorâmica Inicial

Fig. 1 Initial radiographic image

002   Provisório Após 90 Dias De Pós Operatório

Fig. 2 Provisional after 90 postoperative days

003   Perfil De Emergência Após 90 Dias De Pós Operatório

Fig. 3 Emergence profile after 90 postoperative days

004   Personalização Do Transferente Com Resina Pattern Fotoativada

Fig. 4 Transfer customization with photo-activated pattern composite

005   Moldagem De Transferência

006   Moldagem De Transferência

Figs. 5a and 5b Transfer molding

007   Planejamento Da Coroa Em Zircônia

Fig. 6 Planning of zirconia crown

008   Planejamento Da Coroa Em Zircônia

009   Planejamento Da Coroa Em Zircônia

010   Preenchimento Com Cimento Resinoso Antes Do Extravasamento Do Cimento

Figs. 7a and 7b Filling with resin cement before cement removal

011   Preenchimento Com Cimento Resinoso Antes Do Extravasamento Do Cimento

012   Extravasamento Do Excesso De Cimento

Figs. 8a to 8b Operative clinical sequence that allows for excess cement removal

013   Extravasamento Do Excesso De Cimento

014   Excesso De Cimento Preso Do Análogo

Figs. 9 Analog with excess cement

015   Coroa Cimentada

016   Coroa Cimentada

Figs. 10 Cemented Crown

017   Radiografia Final

Figs. 12 Final X-Ray