Full Arch Implants – Welded Conometric Case

Bill Schaeffer

BDS MBBS FDS RCS MRCS

The Implant Centre

2,882 views

Introduction to the case

Nothing new in the technique here – this is just one of my standard welded conometric cases. It just turned out nicely so I thought I’d post it. The plan is to remove the lower molar and all the upper teeth and to place some implants lower left and upper jaw.

The only tough decision I had was whether to do this case as a hybrid (pink and white) or as a socket-fit bridge (just white).

The patient has lost quite a lot of vertical height of bone – but not evenly – so I decided to go with the nice and simple hybrid. I have just added his PAs from Monday’s review and integration check. These are from two months after implant placement and loading.

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Lateral Incisor Implant Placement and Provisional

Introduction to the case

Pt. presented to my office w/ multiple congenitally missing teeth and existing upper/lower acrylic partials. She finally made up her mind to move into implants to improve her quality of life. For #7, a Nobel Replace select 3.5 X 11.5 was placed and immediately temped w/ a screw retained provisional made over a plastic engaging cylinder w/ access hole through the cingulum. Tooth was taken out of occlusion and all excursions. Pontic was easily cut off her existing partial. I placed the top of the implant 3mm apical to where I wanted the margin of the facial tissue to settle, which buried the implant .5-1mm subcrestal. A final radiograph was taken w/ the screw retained temp in place and I noticed that the cylinder was not completely seated, probably because of the subcrestal placement. Being this is a provisional restoration, I didn’t think much of it, but was curious to see everyone’s thoughts.

When I made the provisional, I screwed down the engaging cylinder, but did not take a confirmation radiograph (mistake?). I then loosened the screw so I could pull the cylinder out with the luxatemp synch impression (mistake?). Either one of these reasons could be why the cylinder was not seating all the way on the final X-ray. Would like to hear everyone’s thoughts and comments about how they make this type of screw down provisional and if they would be concerned that it is not seated all the way. Thanks

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Part 2: Single Stage Implant – Custom Impression Post and Final Crown

Bill Schaeffer

BDS MBBS FDS RCS MRCS

The Implant Centre

1,954 views

Introduction to the case

This is Part 2 of yesterday’s case, which showed the extraction, placement, and temporary. View Part 1 of today’s case.

This patient has almost perfect teeth, but then developed external resorption of their upper right central incisor. They saw an endodontist who told the patient that it wasn’t restorable, and then the patient found their way to me. The patient has kindly allowed me to show their case.

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Single Stage Implant – Extraction, Placement, Grafting, and Loading of the Implant

Bill Schaeffer

BDS MBBS FDS RCS MRCS

The Implant Centre

2,266 views

Introduction to the case

This patient has almost perfect teeth, but then developed external resorption of their upper right central incisor. They saw an endodontist who told the patient that it wasn’t restorable, and then the patient found their way to me. The patient has kindly allowed me to show their case.

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Socket Shield (SS) Technique for Bone Preservation in Anterior Implants

872 views

Introduction to the case

Replacing a single anterior tooth with an implant is a challenge for every dentist. The risk of losing vestibular bone height and soft tissue is unacceptable from an aesthetic point of view. The presence of osteoclasts on the inner surface of the socket walls indicates that the bundle bone will undergo resorption.

Anatomically, the buccal bone of the teeth is thinner than lingual or palatal bone. Therefore, as bundle bone is a tooth-dependent tissue, it will gradually reduce after extraction. Since there is more bundle bone in the crest of the buccal wall than the lingual wall, hard tissue loss will become most pronounced in the buccal wall (Lindhe, Clinical Periodontology and Implant Dentistry, 2008).

These scientific evidences and the clinical experience of immediate implant placement in fresh extraction sockets have led us to think that by preserving the periodontal tissues on the buccal part of the socket, we could prevent bone resorption in this critical area.

The socket-shield (SS) technique provides a promising treatment, better manages the risks, and preserves the post-extraction tissues in aesthetically challenging cases. We need to preserve and use the bundle bone to our advantage.

The principle is to prepare the root of a tooth indicated for extraction in such a manner that the buccal root section remains in-situ with its physiologic relation to the buccal plate intact. The tooth root section’s periodontal attachment (periodontal ligament (PDL), attachment fibers, vascularization, root cementum, bundle bone, alveolar bone) is intended to remain vital and undamaged so as to prevent the expected post-extraction socket remodeling and to support the buccal / facial tissues. (Howard Gluckman, Jonathan Du Toit, Maurice Salama).

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