Saurabh Gupta
Initial Situation
A 44-year-old patient attended the scheduled
dental maintenance appointment complaining of a fractured tooth, which had been
treated endodontically and restored with a crown five years prior. The patient
was a non-smoker and had an otherwise unremarkable medical history. Clinical
assessments revealed little pain during percussion. A periapical radiograph
confirmed the clinical findings and revealed the fracture line to be at the
cervical margin of tooth #24. A horizontal root fracture was diagnosed and the patient
agreed to his tooth being replaced with a metal-free ceramic implant.
Treatment Planning
A digital design
software programme was used for de- signing the surgical guide and for implant
planning. CBCT scans were combined with an open-format surface in the planning
software for gaining a comprehensive clinical insight. The benefits of
prosthetic-based implant planning for achieving optimal function and aesthetics
were considered while accounting for the current clinical situation, including
bone density, soft-tissue type and anatomy, and projected prosthesis. A
customised surgical guide was designed based on the planned position of the
implant. The provisional restoration was digitally designed and fabricated by
the laboratory technician for immediate restoration.
Final Result
Operative Sequence –
Surgical procedure – On
the day of surgery, a pre-surgical dose of 600 mg of ibuprofen and 750mg of
amoxicillin was administered to the patient. Atraumatic extraction was carried
out to remove the root tip. The manufacturer’s instructions were followed for
placing the conventional surgical guide and preparing the implant bed. Implant
indicators were used for preparing and maintaining an accurate vertical
position for placing the monotype zirconia implant. A zirconia implant with a
diameter of 4.0mm, a body length of 11.5mm and an abutment height of 4.0mm was
surgically placed by means of guided surgery without the need for a flap. After
being placed at a torque of 35Ncm, the implant showed good primary stability.
The minor buccal bone defect was corrected using bone cement to enhance the
vestibular ridge contour and to give the crown a natural appearance. A
horizontal mattress silk suture was placed for closure. Also, the acrylic
provisional restoration fabricated prior to the surgery using the implant
design software was inserted immediately after the surgical procedure. A
chlorhexidine mouth rinse, an anti-inflammatory and antibiotics were
prescribed. The suture was removed seven days after the implant placement.
Prosthetic Phase – The
osseointegration was successful and it was planned to restore the implant using
a zirconia crown after four months. The abutment portion was prepared using
Magic Touch burs, and an intraoral optical scan was taken of the abutment
portion of the monobloc zirconia implant. Self-adhesive resin cement was used
after cleaning and air-drying the zirconia surfaces. Excess cement was removed
carefully using dental floss after cementation of the final crown.
Grading of difficulty
Type 1 Immediate Immediately placement
following extraction
Follow up
Control and maintenance
appointments were scheduled six months and one year after placement of the
implant. The implant crown was still functional and no technical complications
were observed at either appointment. The soft tissue surrounding the implant
with respect to site #24 was quite healthy. A periapical radiograph was taken
at the one-year follow-up. Bone re- modelling around the implant was normal and
the level of bone surrounding the border had fully stabilised. The patient was
satisfied with the treatment outcome, in terms of both aesthetics and function.
Scientific Evidence
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Kazazoğlu. “Zirconia dental implants: a literature review.” Journal
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of The Society for Biomaterials, The Japanese Society for Biomaterials, and The
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88.2 (2009): 519-529.
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Ulrich Volz. “Soft and hard tissue response to zirconium dioxide dental
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(2006): 69-72.
- Kniha, Kristian, et al.
“Peri-implant Crestal Bone Changes Around Zirconia Implants in
Periodontally Healthy and Compromised Patients.” International Journal
of Oral & Maxillofacial Implants 33.1 (2018).
- Kniha, Kristian, et al.
“Peri-implant Crestal Bone Changes Around Zirconia Implants in
Periodontally Healthy and Compromised Patients.” International Journal
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“One‐piece zirconia oral implants for single‐tooth replacement: Three‐year
results from a long‐term prospective cohort study.” Journal of clinical
periodontology 45.1 (2018): 114-124.
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