Use of biocompatible materials for enhanced aesthetics and soft tissue stability after implant treatment – Dr BaudotFeatured Products Promotional Features
Posted by: The Probe 11th May 2018
Dr Baudot shares an implant case study to show how treatment can be deemed successful, even in challenging situations, as long as the patient is satisfied.
This case demonstrates the benefits of a dental implant with a zirconia collar and the difference this feature can make both to the treatment outcome and to the patient. It was a very complex case to treat and despite the aesthetic outcome not being absolutely perfect, the products used enabled us to achieve a result that the patient was more than satisfied with. This allows us to determine treatment as successful. I wish to share the case so that colleagues can learn from it and appreciate what can be achieved even in challenging aesthetic situations.
Preserving soft tissue volume
This particular patient presented to the practice with a failing UR1. The tooth was black and non-vital, with a longitudinal fracture on the root (Figures 1 & 2)
so extraction was indicated. A flap was opened (Figure 3) to reveal significant bone loss. With such a huge bone defect in the aesthetic region, the challenge was to provide an aesthetically acceptable restoration.
The tooth was extracted, resulting in total loss of the cortical bone (Figure 4). The surgical site was cleaned and Bio-Oss bone graft material was placed, followed by a collagen membrane with a slow resorption rate (Figure 5). Once the flap was closed, a temporary bridge was anchored on the UR2 and continued to the UR1, providing an aesthetic solution while the site healed. High quality soft tissue incisions are vital for an aesthetic finish when suturing the tissue closed after surgery, as shown in the immediate post operative photo (Figure 6) and the image from eight days later (Figure 7). The volume of the soft tissue is preserved (Figures 8 & 9) with healthy papillae. This, combined with the shape of the crestal bone, provided an ideal environment for implant placement and encouraged a highly aesthetic and functional result
Six months after extraction and guided bone regeneration, a coronally positioned flap was raised and a 13mm TBR Z1 implant with a zirconia collar was placed in perfect alignment with the left central incisor (Figures 10 & 11). With the small incision, it was possible to see the bone volume recreated around the implant. Impressions were then taken and two days later a provisional restoration was fitted, following immediate provisionalisation protocols.
Figures 10 & 11
At a review one week post implant placement, the soft tissue appeared to be healing well (Figure 12). From the occlusal view (Figure 13), you can see the preservation of the soft tissue volume. To maximise aesthetics, the soft tissue was over-constructed in anticipation of the natural shrinkage that occurs during healing.
Figures 12 & 13
Two months later, the soft tissues had healed as planned (Figure 14). It was still possible to see where the flap was raised, as the gingiva was more red in colour and more vascularised, but these would change with maturation to match the surrounding tissue.
This had occurred by a review four months later, along with a little soft tissue shrinkage to produce a good gum line between the two central incisors (Figures 15 & 16). The zirconia collar of the implant was slightly visible, but this was of no concern to the patient. While we could have performed a connective tissue graft to optimise the aesthetic, he had already undergone several surgeries and didn’t wish to have any more. The zirconia collar of the Z1 implant made it possible to stop treatment at this stage – had we used an implant with a titanium collar, we would have had to proceed with another surgery. As the patient was satisfied about what had been achieved, it was perfectly acceptable to follow his wishes.
Figures 15 & 16
Final impressions were therefore taken for the permanent restoration. At the fit appointment for this, the temporary restoration was removed to reveal healthy soft tissue (Figure 17). The final restoration was fitted onto a TBR zirconia abutment (Figure 18), which was placed in the mouth (Figures 19 & 20). The high quality and integrity of soft tissue was evident by the lack of inflammation. This is very typical of the soft tissue when using the Z1 implant with zirconia collar and the final result was more than acceptable to the patient (Figure 21). The post operative radiographs show good anchorage of the implant in the native bone (Figure 22) and show how well the bone substitute material adapted to the zirconia collar as well (Figure 23).
Figures 17 & 23
Upon review, this case shows what the zirconia-titanium implant can achieve. We were able to restore the aesthetics of the anterior teeth, improving the gum line and ensuring stability of the soft tissue (Figure 24). The biocompatibility of the zirconia collar encourages healthy soft tissue. It is far superior in this regard compared to ceramic or gold abutments and it also leads to reduced bacteria around the implant compared to titanium. A study by Rimondini et al[i] demonstrated the benefits of zirconia over titanium, showing a much greater colonisation of bacteria on the latter material (Figure 25). As such, zirconia produces enhanced aesthetics and stability of the soft tissue (Figure 26).
Figures 24 & 26
In time, the biological behaviour of the trans-gingival portion of the implant is improved and we would therefore expect to see the papillae naturally grow to reduce the visible amount of zirconia. This can be seen in the nine-year follow of this case outlined (Figures 27 & 28) showing once again the benefits of the Z1 zirconia collar implant from TBR.
Figures 27 & 28
Hopefully it is clear from this case that even when aesthetics are not absolutely perfect immediately after implant surgery, a more than satisfactory result can be achieved with careful material selection. Ultimately, we need to aim for results that our patients will be happy with – a very satisfied patient in this case made treatment a success.
For more information visit Dental Express at www.dental-express.co.uk, call 0800 707 6212 or learn more about the Z1 implant at http://z1implants.co.uk/
Dr Fabrice Baudot, DDS, completed an MSc in Medical Biology Sciences, as well as postgraduate qualifications in periodontology, in Paris. He has a special interest in periodontal microsurgery, implantology and Laser microsurgery. Dr Baudot is also a member of the National Union of Periodontists and Implantologists, a member of the American Academy of Periodontics and a founding Director of the Periodontal Microsurgery Institute in Nice. In addition, Dr Baudot has taught and lectured on his chosen topics across the globe.
[i] Rimondini L. et al. Bacterial conolization of zirconia ceramic surfaces: An In Vitro and In Vivo study. The International Journal of Oral and Maxillofacial Implants (2002); 17(6): 793-8
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