Canada (EN)
CLINICAL CASE
Nobel Biocare N1™ system Immediate placement and loading of a single tooth restoration in the premolar area
Dr. Giacomo Fabbri, Italy
Patient: 51-year-old female, smoker.
Clinical situation: Intraoral examination revealed no clinically significant findings with the exception of the maxillary second premolar (Universal Numbering System 13), previously endodontically treated with radiographic and clinical signs of a vertical root fracture.
Surgical solution: Considering the favorable soft tissue volume and architecture and intact buccal bone, it was decided to proceed with an immediate implant placement and temporization.
Restorative solution: Immediate temporization using a digital workflow with TempShell at the N1 base level.Final restoration was fabricated from full-contour zirconia using a Universal Abutment at the N1 base level.
Surgery date: February 2021.
Total treatment time: 12 weeks.
Tooth position: 25.
Surgical procedure
After tooth extraction the implant site was prepared in accordance with the manufacturer's instructions for the Nobel Biocare N1 Implant system. The pilot osteotomy was created with the OsseoDirector™, then the final osteotomy was created with the OsseoShaper™ to a torque of 23 Ncm. An N1 RP 13 mm implant was placed achieving 51 Ncm of final implant insertion torque.
The implant was placed approximately 3.5 mm below the buccal free gingival margin. The flat side of the trioval was placed on the buccal aspect in accordance with the manufacturer's instructions (left).
The Xeal™ N1 Base RP 1.75 mm was placed immediately after the implant placement and tightened to the final torque of 20 Ncm (right).
The N1 Base was placed using a plastic handle, then once in situ the final torque was achieved using the N1 Base screwdriver attached to the dedicated prosthetic torque wrench.
N1 Base in situ. The new trioval prosthetic platform is located about 1.75 mm below the buccal soft tissue level.
N1 Base titanium temporary abutment was placed in order to proceed with an immediate temporization using the fully digital workflow of a TempShell provisional. The screw access channel was closed with Teflon in order to protect the screw head during the restorative procedure.
The temporary abutment was fixed to the TempShell using flowable composite. The temporary restoration was then placed in situ and tightened to 20 Ncm with Omnigrip Mini. The clinical view shows the result immediately after the surgery.
Clinical view immediately after the surgery (left).
Clinical view at 4 weeks after the surgery (center).
Clinical view 10 weeks after the surgery (right). Note the excellent tissue stability and appearance.
X-ray evaluation immediately after the surgery (left).
X-ray evaluation 10 weeks after the surgery (right).
The temporary restoration was removed 10 weeks after the surgery to take the final impression. Soft tissue volume, morphology and quality appeared stable and healthy (left).
Occlusal view of the clinical situation 10 weeks after the surgery (right).
Restorative procedure
Final impression was acquired using an intraoral scanner and the IOS Healing Abutment N1 Base. Clinical view and the X-ray show the IOS abutment in situ.
The final restoration on a Universal Abutment was designed and planned using DTX Studio™ Lab.
The final restoration was designed and planned using DTX Studio software and the Universal Abutment.
The final restoration was designed and planned using DTX Studio software and the Universal Abutment.
The final restoration was designed and planned using DTX Studio software and the Universal Abutment (left).
A NobelProcera® full-contour zirconia crown was cemented in the lab on the Universal Abutment in order to obtain a final screw-retained restoration (right).
Occlusal view of the restoration on the 3D printed model and intraorally.
Outcome
Final result: Clinical and radiographic evaluation showed excellent marginal bone levels with ideal and stable soft tissue architecture. The screw access channel was closed with Teflon and composite.
Initial situation and the final result: Cinical views show excellent tissue stability.
X-ray and clinical evaluation after 9 months of function. Note the excellent bone and soft tissue health.
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