Immediate Implant Placement and Provisionalization - Zimmer Dental

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CE 1Figure 5C—Creation of the sculpted implant receptacle site withPRP inserted into the osteotomy site.Figure 5D—Prepared, polished stock abutment seated.Figure 5E—Provisional restoration cemented.Figure 5F—Emergence profile formation at 3 monthspostoperatively.Figure 5H—Case complete periapicalradiograph.Figure 5G—Final implant-supported restoration.restoration can be cemented with a temporarycement, and once again, confirmation of nonloadcan be obtained.Suture MaterialA 5.0 monofilament (Monocryl d ), or4.0 Vicryl Rapide suture is recommended.The suture is small enough in diameter andresorbs over 30 to 45 days (Vicryl Rapide in10 to 14 days), allowing proper stabilizationand maturation of the soft tissues.Postoperative CourseAs stated earlier, the prescribed healingphase is 3 months in immediate extraction ordEthicon, Inc, Somerville, NJ 08876; (800) 255-2500edentulous ridge cases, and 4 to 5 months insinus grafted cases. After 3 to 5 months, if therestorative clinician uses the stock abutmentseated at the initial visit, the abutment istorqued to 30 Ncm, and the temporary is recemented.Routine restorative procedures arefollowed from that point.If the restorative dentist requests acustom abutment, the patient is referred back tothe restorative clinician for routine impression6 Compendium / February 2003 Vol. 24, No. 2
CE 1Figure 6A—Preoperative view of the mandibular left posteriorsextant at teeth Nos. 19 and 20.Figure 6B—TempStent seated clinically after creation of thesculpted implant receptacle site.Figure 6C—Seating the prepared, polished stock abutments.Figure 6D—Closure and the left lateral clinical view.techniques at fixture level with a transfer coping.When fabrication of the custom abutment iscompleted, the abutment is seated and torquedat 30 Ncm, and completion of the implant supportedrestoration proceeds as normal.The case reports that follow describe theimmediate implant placement and provisionalizationprocedure outlined in an edentuloussite, an immediate extraction site,and a sinus grafted site.Case 1—Single Tooth ImplantA 33-year-old woman (nonsmoker) presentedfor implant reconstruction at the edentuloussite at tooth No. 8 (Figure 5A). The preoperativeperiapical radiograph is shown in Figure 5B.After completing a diagnostic waxing of boththe hard and soft tissues that need to bereplaced, the clinician can evaluate the necessaryregeneration procedures that need to be performed,in conjunction with implant placement;ascertain the width and length of the plannedfinal restoration; plan soft tissue contours; andfabricate a surgical stent/provisional restoration(TempStent ).After administering an appropriate localanesthetic and full-thickness flap elevation,the clinician prepares a sculpted implantreceptacle site in the alveolar crest (Figure 5C)by mimicking the flow of the facial bone marginsfrom tooth No. 8 to tooth No. 10. Thissculpted implant receptacle site also allows thecreation of interdental bone contours (Figure5C) and osseous foundation, which sculpts theemergence profile of the final restoration.After atraumatic site preparation, the clinicianapplies PRP to the osteotomy site (Figure 5C)and coats the implant surface with PRP beforeplacement. A 4.7-mm Tapered Screw Vent e ,HA-coated, 13-mm length implant is placed inthe osteotomy site. After implant placementand removal of the implant carrier, an HLA4/5 stock abutment e is prepared and polishedextraorally, and securely seated in the implant(Figure 5D).Retrofitting of the TempStent surgicalguide/provisional restoration completes thetransitional restoration, while marginal adaptationis completed with the abutment that hasbeen prepared extraorally. After the abutment/provisionalmargins have been adapted,the entire abutment/temporary restorationcomplex is reinserted and cemented, respectively,at the implant site (Figure 5E).Cementation is completed with a strong temporarycement. Veneering of the buccal plateVol. 24, No. 2 Compendium / February 20037
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Immediate Implant Placement and Provisionalization - Zimmer Dental

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