Crest Preservation with Immediate Implant Placement
After clinical and radiographic evaluation due to poor prognosis of the existing dentition. The treatment plan was to extract all the existing lower teeth and in addition to remove the 2 failed implants 45,46 (29,30) while keeping implant 33 (22) in place. Thereafter, to perform immediate implant placement of 3 implants and simultaneously augment and preserve the crest. The final prosthetic plan was to provide the patient removable overdentures on those implants.
After extraction and complete debridement, implants were placed with good primary stability and the crest was.
The flap was raised and minimally dissected for release, the release should be as minimal as required in order to have moderate tension during the closure, not tension free. Hard tissue was prepared and the implant (DMI Technologies Ltd.) was placed submerged by one millimeter below the crest with good primary stability, it’s important that the implant is anchored to the bone in order to regain their primary stability.
Thereafter, Augma’s Bond Apatite Cement was used to augment the crest.
After activation of the cement within its syringe it was ejected directly above the implants and above the crest and slightly overfilled. Thereafter pressed for 3 seconds using a dry gauze pad above. ( An instrument should not be used to push the cement between the implant and the socket walls .)
Following the placement of the cement, soft tissue closure occurred. The cement was covered directly by the flap and no membrane was used. The flap was sutured in place with moderate tension. ( it’s important that the soft tissue closure shouldn't be tension free as within the conventional augmentation technique's ).
The Soft tissue should be maximally closed, do not leave the cement exposed more than 1-3 mm.
3 Months post op.
- Healing went uneventfully and re-entry took place after 12 weeks.
- During re-entry a diamond bur was used to remove excess bone grown above the cover screws, integration of the implants was achieved and ball attachments were connected to the implants
Surgery Performed by Dr. Ilia Mushayev DMD