//Predictable and versatile

Predictable and versatile

2017-12-13T12:20:28+00:00

The first part of this series, published in Implant Dentistry Today’s May issue, discussed the Easy EM (Bioner) implant system’s versatility, predictability and ease of use. The benefits of the system allow clinicians to put patients’ best interests first. In this article, I will present two case studies using the Easy EM implant system. The cases I’ve selected were all suitable candidates with no medical issues and non-smokers. In the single implant case, there was an abundance of bone in volume and density. In the multi-unit case there were limitations in the amount of available bone, so an All-on-4 approach, using Arton Systems for immediate load and restoration, was used. This demonstrates the versatility of the implant. Case one demonstrates the replacement of a first molar using an Easy EM implant. A screw-down type of crown was used and the screw hole was sealed using PTFE tape and composite filling material. Case two demonstrates the use of Easy EM as a predictable solution in immediate load cases using orthopantomogram (OPG) imaging. In both cases, full notes and X-rays are available for scrutiny; dentists can email me for further information. Patients have signed the necessary consent to allow use. Case one: single implant A 51-year-old non-smoking male in good health with no medical concerns, and a relatively good social history in terms of diet – although he had been a ‘sweet eater’ – presented. He requested an implant solution as he was developing occlusal problems due to the mesial drifting of the second molar, and was eager to address several concerns he had in his mouth, which occurred through years of neglect.

The treatment plan included the placement and restoration of one root form Easy EM implant in the molar area. A delayed staged approach was followed, where implants were placed and allowed to heal for three months before impressions were taken. The decision was made to place a gum former at the time of placement, which eliminated the need for uncovers surgery later. The patient saw another dentist to start work on the second molar. At the impression stage, an abutment was attached to the implant with a ‘ball top screw’, which allowed for a closed tray impression using a stock tray. The impression material of choice was Impregum (3M Espe) and an opposing Penta and bite registration was done. The shade was selected and then sent to the laboratory with a prescription to have a ‘screw down’ crown made from porcelain fused to precious metal. The use of Impregum is recommended due to its dimensional stability; when the ball top screw and impression are removed and clipped into the impression, the feeling is very positive. This makes the casting technique predictable and ensures that the laboratory analogue is in the correct position when the crown is fabricated.

At the delivery stage, the procedure was straightforward. The healing cap was removed and soft tissue healing around the implant was assessed. The implant was rinsed with a syringe containing Corsodyl mouthwash. The abutment/crown was then placed into the implant and clicked into place, and the abutment screw tightened to 30Ncm. The screw hole was filled three quarters with PTFE tape and then sealed with a composite. The occlusion was checked and adjusted, and the patient advised to have a night guard made. The patient was satisfied with the result, and expressed a wish to have his remaining teeth whitened. The procedure involved three treatment visits, excluding the initial consultation and diagnostic appointments over a period of four and a half months. Case two: multi-implant The Easy EM implant can be used in most implant treatments ranging not only from single implants to multi-implant cases, but also for allowing immediate load in full arch cases. The thread pattern of the implant does offer a predictable primary fixation, which allows it to be loaded immediately.

The restorative phase took place immediately after the implants were placed and flaps were sutured into place. Multi-unit abutments were selected and screwed into place. The angles and heights of the abutments were chosen by placing the surgical template over the implants to ensure that the screw holes opened witching the occlusal arch posteriorly and in the lingual area anteriorly. Once satisfied that the correct abutments were in place, plastic ‘clip-on’ impression caps were put in place and Impregum final impressions were taken. Bite registration was done using the white caps with Blu-Mousse (Parkell) to finalise jaw relationship, and also, face bow registration. This information was then handed to the technician who then spent six hours fabricating the prosthesis. Figure 8 was taken 24 hours after surgery and it is significant to observe how there is virtually no inflammation in the supporting soft tissue. Figure 9 shows the follow-up suture removal appointment. Soft tissue healing was good and the effect of the grafting is obvious where the ‘gum fit’ of the prosthesis is evident. The occlusal view of the prosthesis can be seen in Figure 10. A 2mm vacuum-formed night guard was delivered as the patient did show signs of bruxism in his original dentition. The patient is extremely satisfied with the outcome of his treatment and has requested that the same be done in the maxilla.

At the delivery stage, the procedure was straightforward. The healing cap was removed and soft tissue healing around the implant was assessed. The implant was rinsed with a syringe containing Corsodyl mouthwash. The abutment/crown was then placed into the implant and clicked into place, and the abutment screw tightened to 30Ncm. The screw hole was filled three quarters with PTFE tape and then sealed with a composite. The occlusion was checked and adjusted, and the patient advised to have a night guard made. The patient was satisfied with the result, and expressed a wish to have his remaining teeth whitened. The procedure involved three treatment visits, excluding the initial consultation and diagnostic appointments over a period of four and a half months. Case two: multi-implant The Easy EM implant can be used in most implant treatments ranging not only from single implants to multi-implant cases, but also for allowing immediate load in full arch cases. The thread pattern of the implant does offer a predictable primary fixation, which allows it to be loaded immediately.

The major benefit for the patient is that the prosthesis is the final one, and if any adjustments need to be made, they can be taken care of without the need for the patient to be without their teeth for any period of time. For the dentist, the benefit is that the prosthesis never needs to be remade, and any changes that need to be affected can be done with minimal disruption and cost. The surgical aspect revolved around the removal of the remaining teeth, except the lower left second molar. A crestal and sulcular full thickness flap was raised with a release incision in the left lateral incisor area. The alveoli were carefully debrided and cleaned using a piezo handpiece and curettes. Alveoloplasty of the irregular alveolar ridge was then performed using a double action rongeur and a rose-head bur on a surgical straight handpiece to create an even uniform ridge in preparation for implant placement. Care had to be taken as the inferior dental foramina both left and right side were fairly superficial to the crest of the alveolar ridge. The implant sites were then selected and four Easy EM implants were placed. The distal implants had to be angled due to the position of the inferior dental nerve and the amount of available bone. After placement of the implants, the sockets were grafted to ensure that the alveolar ridge would not collapse during healing phase, and that the graft would help to maintain the soft tissue support. The graft and mandibular ridge was then draped with A-PRF, which was prepared from a phlebotomy procedure at the start of the appointment. The A-PRF acts like a membrane by holding the graft material in place and it also helps to speed up healing and reduce inflammation.