Placement of a PREVAIL Implant in the posterior region: a case presentation
Author_ Alan Meltzer USA
_Initial patient presentation
A 50-year-old female patient presented with bone loss in the mandibular right posterior quadrant. The teeth in this quadrant present with questionable-to-hopeless long term prognosis. The patient desired a fixed restoration to replace her soon-to-be missing teeth.
Severe periodontitis with advanced bone loss, tooth number 29 and 31
Normal soft-tissue contours number 29 and 31
Inadequate bone volume for implant placement
Altraumatic extraction of teeth number 29 and 31, debridement of extraction sockets and placement of FDMB allograft and OSSIX Membrane.
Healing (five months).
Placement of two OSSEOTITE Certain (internally interfaced) implants and placement of EP (Emergence Profile System) healing abutments (5 mm diameters) in a flapless, single-stage surgical protocol
Eight weeks following implant placement, removal of healing abutment and implant level impressions.
Placement of a definitive metal-ceramic fixed partial denture.
The hopeless teeth number 29 and 31 were carefully extracted and particulate bone graft material placed into the extraction sockets. Healing was uneventful for the next five months. Two OSSEOTITE Certain (internally interfaced) Implants were placed in a single-stage protocol (punch technique). Tooth position number 29 received a 4mm platform diameter x 10 mm length Certain PREVAIL Implant and tooth position number 31 received and 8.5 mm length 5/6 OSSEOTITE XP Certain Implant. Consistent with the single stage protocol, an EP (Emergence Profile System) Healing Abutment (4mm implant restorative platform x 5 mm EP Flare x 4 mm trans tissue height) was placed onto the implant (with an audible and tactile sense of complete seating) in tooth position number 29. An EP Healing Abutment (5mm implant restorative platform x 5mm EP Flare x 4mm trans tissue height) was placed on the implant in tooth position number 31. Since there was minimal bone volume superior to the inferior alveolar canal apical to tooth number 31, an implant that was 8.5 mm in length was placed to avoid the need for nerve repositioning or vertical augmentation. The clinician also chose to perform Platform Switching of the implant by placing a smaller diameter healing abutment onto the larger diameter implant seating surface to attempt to preserve the crestal bone around the short implant. Since there was no incision and subsequent need for soft tissue closure with sutures, healing was relatively painless and uneventful. Radiographic verification of full seating of the healing abutments to the implants was noted, and the patient was discharged with antibiotic and anti-inflammatory prescriptions.
Eight weeks following implant placement, the healing abutments were removed, and the implants were confirmed to be stable. An implant level impression was made using appropriately sized pick-up type implant impression copings. The impression copings were inserted in to the internal interface of the implants with an audible and tactile click that ensured complete seating. An intraoral radiograph was taken to verify complete seating of the impression copings and a definitive implant level impression was made. The healing abutments were placed back into the implants. An impression of the opposing arch, interocclusal registration and shade selection were sent to the commercial dental laboratory for fabrication of custom UCLA Abutments and a PFM three-unit cement retained fixed partial denture.
The healing abutments were removed and custom abutments were placed onto the implants. The abutments were secured with Gold-Tite Abutment Retaining Screws and tightened to 20 Ncm of torque. Screw tightness was verified with a Restorative Torque Indicator. The screw access holes of the custom abutments were filled with a protective material (composite resin over cotton) and the three unit PFM FPD (Fixed Partial Denture) was tried in. following radiographic verification that the retainers of the FPD were completely seated onto the custom abutments, the FPD was adjusted for optimal occlusion and secured to the abutments with Durelon cement. The patient was instructed on proper self-care and dismissed.
Extraction of the hopeless teeth and immediate grafting with bone was performed prior to implant placement due to the minimal amount of available bone for implant placement above the inferior alveolar canal. The clinicians choice of performing a single-stage surgical protocol and tissue punch technique for implant placement reduced postoperative discomfort and promoted faster healing. This case demonstrated crestal bone preservation in the mandibular posterior quadrant, in an area of limited bone height above the inferior alveolar canal. In over to preserve the height of the existing bone, the clinician chose to Platform Switch an expanded platform implant in tooth position number 31 and place a Certain PREVAIL Implant in tooth position number 29. At the try-in appointment, both implant sites demonstrated radiographic preservation of the crestal bone. The unique benefits of the new Certain PREVAIL Implant include having Platform Switching built into the coronal aspect of the implant. This feature avoids confusion in the selecting mismatched sized components at the surgical, restorative and laboratory phases.
3i and design, Certain, EP, Gold-Tite, Implant Innovations, OSSEOTITE, OSSEOTITE XP and PREVAIL are registered trademarks of Implant Innovations, Inc., a Biomet Company. Durelon is a trademark of 3M ESPE. OSSIX is a trademark of Colbar Lift Science Ltd.