{"id":354566,"date":"2022-04-04T22:02:47","date_gmt":"2022-04-05T01:02:47","guid":{"rendered":"https:\/\/fgmdentalgroup.com\/?p=354566"},"modified":"2023-01-31T08:58:35","modified_gmt":"2023-01-31T11:58:35","slug":"treatment-of-a-fracture-on-an-upper-central-incisor-with-rehabilitation-through-immediate-implant-carried-out-with-a-virtual-surgical-guide-a-clinical-case-report","status":"publish","type":"post","link":"https:\/\/fgmdentalgroup.com\/intl\/blog\/posts\/treatment-of-a-fracture-on-an-upper-central-incisor-with-rehabilitation-through-immediate-implant-carried-out-with-a-virtual-surgical-guide-a-clinical-case-report\/","title":{"rendered":"Treatment of a fracture on an upper central incisor with rehabilitation through immediate implant carried out with a virtual surgical guide: a clinical case report"},"content":{"rendered":"\r\n

Authors: Prof. Augusto Bessa and Prof. \u00cdris Sol<\/em><\/p>\r\n\r\n\r\n\r\n

Initial evaluation<\/h3>\r\n\r\n\r\n\r\n

Male patient, 61 years old, went to the private dental clinic after suffering trauma to dental element 21 (Fig. 1). The clinical examination showed mobility of the crown, and the horizontal fracture was confirmed by the periapical radiographic examination (Figs. 2 and 3), and surgical removal of the root and rehabilitation with an implant was indicated. After the tomographic examination, the case was built virtually in the 3Shape Implant Studio program, and the planning for the atraumatic exodontia of the root remains was carried out (Fig. 4), aiming to preserve the sorrounding bone structure and facilitate the surgery for installing the immediate implant. The chosen implant system was Arcsys by FGM.<\/p>\r\n\r\n\r\n\r\n

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Fig. 1- Initial clinical examination.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 2- Fracture of the dental element of tooth 21 confirmed through a periapical x-ray.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 3- Removal of the fragmented crown.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 4- Atraumatic extraction of the dental element of tooth 21.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

Before the surgery, the virtual surgical guide was planned, joining the STL file of the scanning to the DICOM file of the tomography in a specific planning software (Figs. 5 and 6).<\/p>\r\n\r\n\r\n\r\n

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Fig. 5- Planning for the 3Shape surgical guide.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 6- Approved surgical report.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

With the aid of the surgical guide printed from the virtual planning (Fig. 7), the surgical instrumentation was executed to install a 3.8 mm x 13 mm implant (Fig. 8). The implant was installed (Fig. 9) and anchored to the alveolus. A 3 mm x 6 mm Arcsys prosthetic abutment with a 4.5 mm transmucosal portion was activated according to the protocol recommended by the manufacturer. The filling with the Nanosynt bone graft with granulation from 500 \u00b5m to 1000 \u00b5m was performed (Fig. 10), associated with the chopped L-PRF fibrin.<\/p>\r\n\r\n\r\n\r\n

A provisional crown was made immediately through the fractured crown, respecting the critical zone (Fig. 11). After polishing and finishing, it was cemented to the abutment with provisional cement (Figs. 12 and 13).<\/p>\r\n\r\n\r\n\r\n

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Fig. 7- Surgical guide.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 8- Surgical drilling bit following the guide.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 9- Installation of the implant.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 10- Filling with Nanosynt and L-PRF<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 11- Provisional crown made.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 12- Provisional crown cemented.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 13- Implant installed and provisional crown captured.<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

After 4 months of waiting for the bone remodeling of the alveolus and the osseointegration of the implant, we proceeded to execute the connective tissue graft, improving the pink peri-implant esthetics. After this step healed (Fig. 14), the prosthetic rehabilitation was planned, also in the digital workflow. For such, the Scan Body for abutments was used, designed with an inspection window to facilitate its visualization on the prosthetic component (Figs. 15 and 16). The selection and photography of the colors were performed to send to the laboratory (Fig. 17).<\/p>\r\n\r\n\r\n\r\n

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Fig. 14 – Peri-implant esthetic after the healing of the connective tissue graft.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 15 – Inspection window of the Scan body abutment.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 16- Scanning of the prosthetic abutment.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 17- Shade selection.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

Considering that the library of Arcsys implants and components is available in the 3Shape software, the CAD operator planned, designed, and milled a zirconia cast and performed the stratification of the ceramics. Upon removing the provisional crown, the healed emergence profile with the tissue positioned favorably was observed (Fig. 18).<\/p>\r\n\r\n\r\n\r\n

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Fig. 18 – Emergence profile.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

The case was finalized with a perfect adaptation (Fig. 19), and the definitive prosthetic cementation was performed (Fig. 20). The replacement of dental elements in the anterior region using the digital flow results in more significant swiftness in the surgical act and facilitates the clinic’s day-to-day, increasing the comfort, precision, and quality of the results.<\/p>\r\n\r\n\r\n\r\n

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Fig. 19 – Definitive crown tryout. the fit between the crown and the tissue.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
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Fig. 20 – Final cementation.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

References<\/h3>\r\n\r\n\r\n\r\n
    \r\n
  1. Cat\u00e1logo de produtos da FGM Dental Group;<\/li>\r\n\r\n\r\n\r\n
  2. Regenera\u00e7\u00e3o \u00d3ssea Guiada na Implantodontia
    Daniel Buser \u2013 Quintessence Editora \u2013 2010<\/li>\r\n\r\n\r\n\r\n
  3. Regenera\u00e7\u00e3o Guiada Tecidual
    Mauro Cruz \u2013 Editora Santos \u2013 2006<\/li>\r\n\r\n\r\n\r\n
  4. Enxertos \u00f3sseos em Implantodontia
    Jean-Fran\u00e7ois Tulasne e Andre\u00e1ni \u2013 Quintessence Editora \u2013 2010<\/li>\r\n\r\n\r\n\r\n
  5. Enxertos \u00d3sseos em Implantodontia
    Reanato Mazzonetto et al. \u2013 Napole\u00e3o Editora \u2013 2012<\/li>\r\n\r\n\r\n\r\n
  6. Transplantes \u00d3sseos na Implantodontia
    Andr\u00e9 Antonio Pelegrine et al. \u2013 Napole\u00e3o Editora \u2013 2008<\/li>\r\n\r\n\r\n\r\n
  7. Cat\u00e1logo de produtos da FGM http:\/\/www.fgm.ind.br\/site\/produtos\/implantesbiomateriais\/substituicao-ossea-nanosynt\/<\/li>\r\n\r\n\r\n\r\n
  8. Choukroun, J. (2001) Une opportunit_e en paroimplantologie: le PRF. Implantodontie, 42, 55\u2013 62. French.<\/li>\r\n\r\n\r\n\r\n
  9. Pan J, Xu Q, Hou J, Wu Y, Liu Y, Li R, Pan Y, Zhang D. Effect of platelet-rich fibrin on alveolar ridge preservation: A systematic review. J Am Dent Assoc 2019; 150:766-78. doi: 10.1016\/j.adaj.2019.04.025.<\/li>\r\n<\/ol>\r\n","protected":false},"excerpt":{"rendered":"

    Male patient, 61 years old, went to the private dental clinic after suffering trauma to dental element 21 (Fig. 1). The clinical examination showed mobility of the crown, and the horizontal fracture was confirmed by the periapical radiographic examination (Figs. 2 and 3), and surgical removal of the root and rehabilitation with an implant was indicated.<\/p>\n","protected":false},"author":15,"featured_media":354567,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"produto-relacionado":[],"categoria-post":[1024],"linha-de-atuacao":[483],"class_list":["post-354566","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","categoria-post-clinical-case","linha-de-atuacao-product-implants"],"_links":{"self":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/posts\/354566"}],"collection":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/comments?post=354566"}],"version-history":[{"count":0,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/posts\/354566\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/media\/354567"}],"wp:attachment":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/media?parent=354566"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/categories?post=354566"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/tags?post=354566"},{"taxonomy":"produto-relacionado","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/produto-relacionado?post=354566"},{"taxonomy":"categoria-post","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/categoria-post?post=354566"},{"taxonomy":"linha-de-atuacao","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/linha-de-atuacao?post=354566"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}