Authors: Dr. Jéferson Fagundes
Patient gender and age: Female patient, 67 y.o.
Chief complaint: Absence of tooth 12 and aesthetic dissatisfaction
Initial evaluation: After anamnesis, clinical and tomographic examination, a thin alveolar bone structure was observed in the region of element 12 and volume loss of soft tissue, indicating tissue reconstruction associated with implant installation.
Treatment performed
A 3.3×9 Arcsys implant was installed in the region of the element 12, with a torque obtained of 50Ncm. After the implant was installed, a vestibular bone wall fenestration was observed (which was expected, due to the thin bone wall). Soon after, the angular referrer was attached to the implant to personalize the angle of the 3x6x2.5 Arcsys sleeve. After customizing the trunnion to the Arcsys angulator in 6 degrees, the prosthetic component was installed on the implant with the hammer. Then, the autogenous conjunctive graft and the Nanosynt bone graft were applied to the buccal bone wall and protected by an absorbable collagen membrane. The provisional crown was made directly on the multifunctional peek transfer with flow resin. The surgery was completed using PTFE sutures. After 120 days, definitive restorative procedures were initiated, by making ceramic zirconia / feldspathic crowns on teeth and on the implant 12.
FIG. 1 – Initial aspect
FIG. 2 – Initial tomographic section
FIG. 3 – Initial lateral aspect
FIG. 4 – Incisal initial aspect
FIG. 5 – 3,3 x 9 Arcsys implant
FIG. 6 – Implant installed 2mm infra-bone
FIG. 7- Incisal view of the implant
FIG. 8- Angle referrer coupled
FIG. 9- Angulation determined for the abutment
FIG. 10- Angulation customized in 6 degrees
FIG. 11- Abutment installed and Bone graft
FIG. 12- Nanosynt bone graft
FIG. 13- Collagen membrane placed
FIG. 14- Multifunctional transfer over the abutment
FIG. 15- Provisional crown installed
FIG. 16 – Surgery completed
FIG. 17- Lateral postoperative appearance
FIG. 18 – Panoramic image after 30 days
FIG. 19- Clinical aspect after 90 days
FIG. 20- Digital prosthetic planning
FIG. 21- Ceramic crowns on the model
FIG. 22- Cemented crowns: case completed
FIG. 23 – Lateral view: case completed
FIG. 24 – Zoomed image element 12
FIG. 25 – Before/After: lateral view
FIG. 26 – Before/After: frontal view
