CASE REPORT
This case describes a successful treatment outcome of a hopeless tooth in the esthetic zone with thin gingival biotype using the Straumann® BLX Implant System, botiss cerabone® and botiss mucoderm®.
Introduction
Reaching and maintaining optimal gingival esthetics around implants in the anterior region is a challenging task. One of the main characteristics of immediate implant placement and provisionalization is its effectiveness in the esthetic outcome, preserving the existing bone and gingival architecture. Adequate primary stability is a prerequisite to enable this type of treatment. The implant design plays an important role in this context. According to recent clinical trials, the new Straumann® BLX implant offers the ideal properties for these clinical situations. At the same time, the SLActive® surface has an impact on the early osseointegration of immediately restored implants.
Initial situation
A 25-year-old male patient visited our clinic with a fractured right lateral incisor (Figs. 1-4). The patient presented in good oral and systemic health with no smoking habits. Cone beam computed tomography (CBCT) showed the root positioned towards the buccal wall and sufficient apical bone allowing immediate implant placement. (Fig. 5). As the fractured tooth was in the esthetic zone, the patient needed a restoration as soon as possible.
Treatment planning
Given the clinical and radiographic situation, immediate implant placement and restoration was chosen as the treatment option, with the placement of a Straumann® BLX Roxolid®, SLActive® 3.75 x 12 mm implant with immediate temporary abutment and chairside tooth shell pick-up. A multifunctional guide (surgical guide and future provisional restoration) was made prior to surgery. (Fig. 6)
Surgical procedure
Under local anesthesia, and following a minimally invasive extraction, a distance of 3 mm was observed between the gingival margin and the bone buccal wall margin (Fig. 7). The implant bed was prepared according to the sequence of needle drill plus 2.2 mm pilot drill and 2.8 mm BLX drill (Figs. 8,9), following the position determined by the surgical guide (Fig. 10). After the integrity of the buccal wall was assessed and the prepared osteotomy was checked with the surgical probe (Figs. 11,12), the Straumann® BLX 3.75 x 12 mm implant was placed in the final position with a torque of 50 Ncm (Figs. 13,14). The gap between the implant and the buccal wall was filled with cerabone® (Fig. 15) and after gingival tunneling, botiss mucoderm® was tucked in buccally (Fig. 16).
Prosthetic procedure
The BLX implant was positioned according to the prosthetic plan (Fig. 17). The multifunctional guide was fixed to the temporary abutment with flowable resin (Figs. 18,19), and the slim concave emergence profile concept was applied to the subgingival portion (Fig. 20).
The final prosthesis was prepared in a digital workflow with images captured by the Straumann® Virtuo Intraoral Scanner and a CADCAM process using Straumann CARES Visual. The intraoral scanner captured the 3D position of the implant with the aid of a ScanBody screwed to the BLX implant (Fig. 21). The STL file (Fig. 22) was generated, and we used the Straumann® C series (Fig. 23), to mill a customized lithium disilicate abutment (Figs. 24,25). This customized abutment was cemented extraorally to an RB/WB Variobase® (Fig. 26) with Multilink® cement. A lithium disilicate veneer was placed on this custom abutment (Figs. 27,28). The restoration was seated and screwed to a torque of 35 Ncm (Fig. 29).
Treatment outcome
The patient was extremely happy with the implant placement and the chance to have a restoration immediately after the extraction of his anterior tooth. (Figs. 30-32)
Conclusion
The Straumann® BLX implant provides optimal implant primary stability thanks to its design, enabling reliable immediate provisionalization for the optimum final esthetic result.
A clinical case report by ImplantTeam, Brazil.
First published on: https://www.straumann.com/en/discover/youtooth/article/immediacy/2019/luiz-livia-camargo-lucio-kanashiro-immediate-implant-placement-function-esthetic-zone-straumann-blx
