Immediate Placement and Immediate Loading with Implantswiss Implants and Cerec Work Flow in Single Visit

INTRODUCTION

The immediate placement of implants followed by immediate loading in anterior mandible is an advanced procedure, requiring comprehensive knowledge of digital dentistry. Compendious preoperative digital 3D treatment planning, explicit surgical implementation based on a restorative driven approach is essential for success.

Over the years, popular studies have focused upon the successful placement of implants immediately after extraction in the anterior and molar regions.^1,2 Factors which favour the immediate implant placement after extraction are modification in implant surface, abbreviate treatment time, few invasive surgeries and reduced patient discomfort.

Nowadays, implant dentistry has advanced from the conventional healing protocol of 3–6 months to the most recent trends of immediate placement and loading of implants. Primary stability which is derived from mechanical engagement of the implant threads with the bone is the uttermost necessity for the immediate loading protocol.³ Primary stability compute the threshold of the bone-implant interface to combat the micromovements at implant placement, thereby leading to uninterrupted healing for the attainment of secondary stability, through bone regeneration and remodelling ,evolving in osseointegration.⁴ This is to a great extent impacted by the design, material and surface of the implant, digital preoperative and the placement strategy, and the quality and quantity of the bone. ISQ (Implant stability quotient) measurement by osstell device and CEREC work flow within the clinic space allows immediate loading with customized zirconia restorations in single sitting.

Aim of this case report was to focus on immediate implant placement, the role of ISQ reading obtained by osstell device in determining implant stability and to further decide about immediate loading by Zirconium crowns within few hours, using INDIA’s first in house latest generation CEREC Primemill.

CASE HISTORY

A 52-year-old healthy female patient came to our clinic with mobile teeth in lower front tooth region. She was not able to eat and maintain adequate oral hygiene in lower front region. The patient was concerned about her aesthetics and wished for the single sitting permanent solution due to covid to avoid frequent dental visits. Patient communicated her willingness for immediate implant placement and immediate loading after extraction after a detailed discussion. Patient was advised for OPG x ray and CBCT which revealed sufficient bone for implant placement.

Under local anaesthesia, the mobile teeth were atraumatically removed, so as to restore the natural aesthetics in very short span of time. Flapless osteotomy commenced after extraction. For achieving good primary stability, osteotomy was done around 4 mm apical to the extraction socket to gain anchorage.

Two implantswiss bone level implants measuring 3.7x141mm were placed in good D1 bone (Figure 1) and insertion torque of more than 40 NCM was achieved. Insertion torque is the vital factor in determining, whether or not to load immediately. Immediately ISQ was done with Osstell ISQ device, which showed very promising readings (79 and 78), encouraging for immediate loading. (Figure 2)

Immediately after this stock abutments were placed and intraoral scanning was done with the help of contrast spray and DENTSPLY SIRONA OMNICAM 2. We received 3D printed surface models for proper planning for permanent restoration with Zirconium crowns same day.3D model depicted distinct difference between preparation margin and the gingiva, which authorized the precise duplication of the preparation margin during the subsequent designing process in the CEREC software. (Figure 3)

After that a zirconium trial was made in CEREC primemill with Celtra Duo Blocks to check the fit. Afterwards it was checked for staining and characterisation and glazing was done in CEREC Speedfire and delivered same day. CEREC primemill is INDIA’s first in house latest miling unit.

Acceptable final outcome was accomplished in just single sitting in a perceived manner.Follow up was done regularly and 1 year post op examination showed satisfactory results with minimal amount of bone loss in OPG x ray.(Fig 4)

DISCUSSION

For anterior teeth, immediate implant and immediate loading is a good treatment option because its success rate in the maxilla is 90%–95.5% and in the mandible is 93%–99%.⁵ Certain factors we evaluated carefully for better prognosis of immediate implant and loading in our case are:

We chose a unique implant design with cylindrical design on the neck area and conical design trough the apex of the implant with an osseoconductive surface. Implantswiss implants produced an excellent implant-abutment interface, which fend off the emergence of micro-gap and leakage, because of presence of the universal conical connection and hexagonal index.

Implantswiss bone level implants generated perfect gingival profile and collar cohesion.The atraumatic extractions preserved maximal bone quality and helped in obtaining initial stability.With the intention of conserving the blood supply and enduring soft tissue contours in aesthetic zone, flapless approach was opted for immediate implants.⁶

The Osstell device gives steady results regarding stability of implants and enables to assess the status of implant success. Osstell device works on the principle of piezoelectric transducer to assess implant stability. In our case excellent readings encouraged for immediate loading.

An intraoral scanner is a device, accustomed to capture a digital 3D impression. Imaging sensors capture the 3D image, which is further processed in a special software to assemble a 3D surface model. The digital impression technique enables that processed data is shown quickly on the computer screen and can be evaluated straight away without a waiting period. This technique is economical in long run due to no need of impression copings or implant analogues and also comfortable and time saving.

Scanning powder is used by most of digital systems available in the market and the thickness of the scanning powder compromised the precision of the scans.⁷ To overcome this problem, Dentsply Sirona OMNICAM offers powder free scanning, unparalleled manoeuvre and error free 3D full mouth scans in few seconds in inherent colour. It is easy to adapt with, thus making the scan easy, intuitive and ergonomic. Furthermore, it allows the clinician to choose the colour of the scanned teeth in the software which gave us adequate and conclusive result in our case.

The digital workflow permitted the fabrication of chair side customized crowns, veneers and abutments with supreme quality restorative material like Celtra duo blocks, Zirconium reinforced Lithium disilicate along with aesthetically pleasing results in single sitting.⁸

A milling machine installation in clinic allows the insertion of final restoration within 1 hour in single sitting after implant placement. CEREC Primemill seizes another step forward, to manufactures premium chairside restorations easily, and more precisely in few minutes due to the advanced digital technology and offers a highly calibrated chairside dentistry.

The CEREC workflow - Single-visit restorations allowed us to provide permanent zirconium restoration in single visit. “Beautiful crowns in an hour” This idea is no longer a concept, but a legitimate reality.

CONCLUSION

Acceptable aesthetic and functional outcomes can be achieved in single sitting with immediate implants and immediate loading in the mandibular anterior region with permanent zirconia restorations fabricated chair side within clinic. One of the biggest hurdles a dentist still needs to overcome is the realization that intraoral scanning of crowns and dental implants is now just as accurate, faster, and, in the long run, more economical than traditional impression techniques.

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