Immediate implant – CAD/CAM supported implantology – Nadia’s Story

The treatment with the immediate implant

Why an immediate root analog implant? - Preservation of tissue structures and reduction of necessary surgical interventions

This video documents our experience with CAD/CAM supported implantology and its application with immediate implants.

The treatment is preceded by an anamnesis of the patient with subsequent planning of the rehabilitation strategy.

The patient introduced herself because of toothache of her tooth that had been treated several times by endodontics and reported that the crown had repeatedly loosened. The examination in the RepliDent practice in Munich revealed firstly an increased probing depth and secondly a horizontal fracture on the palatal surface of the tooth.

Before the tooth was extracted, the therapy alternatives were discussed with the patient. Since the adjacent teeth were almost intact, an implant restoration was recommended.

CAD/CAM supported immediate implant - comparison

immediate implant - The advantages

Individual abutment design and soft tissue preservation during treatment with the immediate implant

Despite being informed about the possible risks and insufficient long-term experience, the patient decided to use the Replicate-System immediate implant.

The minimally invasive surgical intervention and maximum preservation of the tissue structures of the anterior region were regarded as the main basis for the decision.

x-ray analysis of the implant insertion

DVT analysis and planning of the dental implant

Acquisition of the natural tooth

With root-analog implants, the replication of the root geometry is carried out by means of a 3-D acquisition of the tooth before its extraction by means of digital volume tomography. Here, advances in digital technology make it possible to link intraoral scan data or STL data indirectly obtained by scanning the master model with digital volume tomography imaging.

On the basis of both data formats, the immediate implant with the abutment can be manufactured CAD/CAM supported prior to surgery.

Manufacturing and planning the Implant and its abudments

CAD/CAM - Manufacturing of implant and abutment

CAD/CAM supported manufacturing process

Using a CAD/CAM-supported manufacturing process, the titanium root of the immediate implant is connected to a zirconium oxide abutment by means of direct fusion using the glass solder technique. In contrast to conventional implant systems, the implant and abutment have no microgap and materials such as composite.

 

Inserting the implant

Inserting the immediate implant

Placement of the Replicate-Implant

The position and fit of the Replicate-Tooth Implant is checked prior to insertion with a sterile zirconia try-in analog, which is part of the treatment protocol. This try-in analogue allows a precise check to be made to ensure that the Replicate-Tooth Implant can be placed in its correct final position before it is finally placed in the alveolar socket.

The Replicate-Tooth Implant was then manually placed in the alveolar socket.

simultaneous bone augmentation

Simultaneous augmentative measures

Condensation of the autologous bone chips

To counteract resorption of the bundle bone, the buccal part of the alveolus was augmented with sufficient autologous bone chips. These can be obtained carefully with twist drills of common implant systems without water cooling and at low rotation (< 80 rpm) in the apical-palatal direction.

Without augmentative measures, tissue structures can regress because the so-called bundle bone resorbs after tooth removal. Simultaneous augmentation measures are necessary to maintain the osseous support for the soft tissue. At the same time, the immediate support of the soft tissue through individual abutment design is a decisive success factor.

Tapping into the correct position was done with a prefabricated insertion aid.

 

adhesivebridge of the immediate implant

Adhesive bridge - minimally invasive implantology

One week after surgery with a temporary adhesive bridge

After placement of the Replicate implant, the Assure primer was reapplied with relative drying and then the temporary bonding bridge was adhesively cemented with Panavia SA Cement Plus Automix (Kuraray Europe). The patient was then instructed on the necessary hygiene measures during the healing phase (6 months) of the immediate implant.

result of the immediate implant one year after the insertion

Insertion of the zirconium crown - 1 year after the operation

The zirconia crown was placed with the glass ionomer cement

Intraoral controls 6 and 12 months after implantation showed very good esthetics and stable soft tissue.

The Replicate implant has been definitively prosthetically restored at the Replident Center Munich using glass ionomer cement (Ketac Cem, 3M Oral Care) with an individualized zirconium oxide crown (Lava Classic, 3M Oral Care, Seefeld) and the veneering ceramic ZI-CT (Willi Geller Creation, Meiningen, Austria).

Treatment team: Dr. Michael Berthold, Dr. Reza Saeidi Pour and MDT Otto Prandtner

Immediate implant - Scientific article

Use of the Replicate system under correct indication for immediate implant placement to help preserve peri-implant structures. Thanks to modern digital technology, it is possible to manufacture root-analog implants with sufficient accuracy of fit.

Corresponding report to Nadia’s story

Immediate implant - experiences

16 months after completion

Find out here how our patient Nadia experienced the treatment with the Replicate System immediate implant and see the aesthetic results.

CAD/CAM dental technology - RepliDent workflow

Construction details

Construction details and dimensioning can be precisely planned and implemented, taking biological aspects into account.