The implant was placed approximately 1.5 mm below the alveolar bone margin. The interdental bone peaks were preserved. Bone substitute material was placed in the gap between the implant and the bone to support the facial bone lamella. Following bone augmentation, an acellular dermal matrix (NovoMatrix®/BioHorizons) was placed to thicken the soft tissue and fixed with sutures. The surgical site was sealed with the hybrid abutment, which was screw-retained in the implant at 20 Ncm. The temporary resin crown, which had been created via the CAD/CAM process, could be inserted after minimal functional corrections. The temporary restoration had no contact in static and dynamic occlusion on purpose to positively influence healing of the implant. Guided immediate implantation and immediate restoration - a state-of-the-art treatment concept Dr. Sven-Marcus Beschnidt, Baden-Baden Due to the deep subcrestal positioning of the implant and to avoid injuring the thin vestibular bone structures during insertion, the titanium bonding base had to be modified in this case. The zirconia abutment was bonded extraorally. The temporary resin crown is attached to the abutment without cement using the integrated snap-on. A drilling template with the PROGRESSIVE-LINE Guide sleeve was used for optimal preparation of the implant site following tooth extraction. Guidance of the drills in the sleeves prevents deflection of the rotary surgical instruments and enables precise positioning of the implant. The root remnant was extracted with maximum preservation of the surrounding tissue. Special attention was paid to preserving the extremely thin facial lamella. For this reason, the root was fragmented and the individual segments removed. Prior to drilling, the granulated tissue was removed from the bone compartment. When inserting the drilling template, its fit was first checked. Support was designed to secure the template against rotation during the procedure. Depth drilling was performed step by step according to the protocol. The drill hole was prepared undersized for the soft bone in the upper jaw. The decision for underpreparation of the Ø 4.3 mm implant site was made prior to surgery. The PROGRESSIVE-LINE Guide Ø 3.8 mm form drills are used for this purpose. As a result, primary stability can be predictably achieved in the extraction socket, where only the lower third of the implant body engages with the bone. A CONELOG® PROGRESSIVE-LINE Implant (Ø 4.3 mm / L 16 mm) was inserted. The screw-retained implant version is to be used for guided surgery. To achieve correct alignment of the inner configuration, appropriate correlating markings are provided on both the insertion post as well as the insertion instrument and the sleeve. Initial findings and digital planning: following a subgingival root fracture, a temporary restoration was performed with a root post and reattachment of the crown. The long-term prosthetic prognosis of the tooth was questionable to poor. Immediate implantation was planned on the basis of digital imaging and 3D diagnostics. After merging the DVT and DICOM data, the optimal prosthetically oriented position of the implant was determined. The abutment was then designed completely digitally. The focus here was on the exact copy of the anatomical tooth shape of the adjacent tooth, from which the design of the crown emergence profile could be deduced. To achieve stable peri-implant soft tissue, the treatment concept provides for the insertion of a definitive hybrid abutment made of zirconia, bonded to a titanium base CAD/CAM. In addition to the provisional crown, the definitive zirconia cap was fabricated preoperatively to avoid any loosening of the abutment from the biological structure. Please note that the images were copied directly from the live recording of the surgical procedure.
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