A metal-free solution for restoring natural esthetics

Case courtesy of Dr. Jens Tartsch.

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Initial clinical solution

Healed site following extraction of teeth in positions 45 and 46, 3 months and 1 year before surgery, respectively.

Treatment planning

Presurgical cone beam computed tomography showed lateral defect near tooth position 45.

Surgical procedure

Cleaning of the alveolar bone at tooth position 45 (left).

Suitable bone for implant insertion at tooth position 46, and lateral defect at position 45 (right).

Surgical procedure

Manual insertion of NobelPearl Ø 4.2 mm x 10 mm using NobelPearl Implant Driver Inter-X following preparation of both sites (left).

Both implants with partially machined collar were inserted 0.6 mm supracrestal. Primary stability was good (right).

Surgical procedure

NobelPearl Cover Screw Inter-X in situ (left).

Horizontal augmentation using deproteinized bovine bone (right).

Surgical procedure

Implants covered with a resorbable collagen membrane (left).

With a two-piece implant system, primary wound closure is possible (right).

Restorative procedure

Orthopantomogram (OPG) at surgery (left).

3-month post-surgical OPG control, before restorative procedure (right).

Restorative procedure

Re-entry after 3 months for placement of two NobelPearl Healing Abutment Inter-X, with a small roll flap (left).

Soft tissue two weeks after re-entry (right).

Restorative procedure

NobelPearl Impression Coping Open Tray Inter-X placed on implants and splinted for precision (left). 

NobelPearl Abutment Straight Inter-X placed on the master cast with gingiva mask (right).

Restorative procedure

Monolithic zirconia crowns placed on the master cast. For stability and because of the augmentation at position 45, the crowns are splinted (left).

Final restoration and abutments before insertion (right).

Restorative procedure

Healthy and thick keratinized peri-implant mucosa seen following removal of the NobelPearl Healing Abutment Inter-X (left).

Try-in of the NobelPearl abutments (right).

Restorative procedure

The screw channels were sealed with Teflon, and abutments prepared for cementation (left).

Restorations cemented to the abutments (right).

Restorative procedure

After cementation, Teflon can be removed through the screw channel (left).

The final restoration was taken out of the mouth for cleaning (right).

Restorative procedure

For the final installation of the restoration the VICARBO® screw is torqued at 25 Ncm and the screw channel is closed again with Teflon band (left).

Final restoration in situ after screw channel closure and sealing with composite to produce a 100% metal-free screw-retained restoration (right).

Outcome

X-ray control after delivery of restoration (left).

X-ray control 6 months after loading, which shows a stable bone level (center).

1-year follow-up, which shows stable bone and even bone gain (right).

Outcome

Excellent esthetic outcome at 1-year follow-up.

Note the healthy soft tissue and natural looking prostheses.

Outcome

Marginal bone stability and great soft tissue response at 4.5 year follow up.