logo 18 • CAMLOG Partner Magazine • July 2018 13 Implant bed preparation with bone condensation After a ridge incision and the preparation of a full flap, the implant position was marked with a round bur. A pilot drill (Ø 2.0 mm) was used to set the implant axis at a depth of approx. 6 mm and to check the implant position with the direction indicator. As the bone quality in the distal maxilla was very soft, the bone site was prepared using osteotomes. Primary stability was achieved by condensation of the bone. Another advantage of osteotome preparation is the prevention of penetrating the Schneider´s membrane, which could be caused by careless handling of the drills. Using the osteotome, the tunnel was widened to correspond to the four millimeter implant diameter. The implant bed was advanced to the full implant length, in this case 11.5 mm, as the implant was to be placed approximately epicrestally (Fig. 3). After the complete preparation of the implant site, the sterile packed CERALOG® Hexalobe implants were removed from the packaging with the insertion tool and prepared for insertion. (Figs. 4 and 5). Epicrestal implant placement Before inserting the CERALOG® Implants, the surface was wetted with the bone-active cells of the PRGF liquid. In our practice, the innovative PRGF® procedure, in which the patient's own growth proteins are used to accelerate healing processes and reduce the risk of discomfort and complications, is used for all implant procedures, irrespective of the material composition. (Figs. 6 and 7). As zirconium dioxide is a poor thermal conductor, slow, pressure-free insertion must be ensured when inserting the zirconium dioxide implants. Implantation was performed with a defined torque of max. 35 Ncm and 15 rpm. The implants were placed minimally supracrestally so that the implant shoulder was approximately 0.5 millimeters above the alveolar bone. (Figs. 8 and 9). The cover caps were clicked into the implant interface to protect against ingrowing bone and tissue ingrowth. The mucoperiostal flap was repositioned tension-free and sutured saliva-tight over the cover caps and a control X-ray was taken. (Figs. 10 and 11). In the invisible region of the maxilla in regions 26 and 27, we dispensed with an interim restoration to protect the implants. The healing of the two CERALOG® Implants was completely symptom-free. The patient had no atypical symptoms whatsoever. Discussions on the healing period for ceramic implants is still ongoing. Longer healing times than with titanium implants are suggested Fig. 4: The presentation of the CERALOG® Hexalobe implants in the packaging. Fig. 5: The insertion tool fits into the inner configuration of the all-ceramic CERALOG® Implant. Fig 6:The mechanical insertion option for the implants. Fig. 7: The implants were immersed in the growth-promoting PRGF liquid prior to insertion. Fig. 9: The correctly positioned and stably inserted CERALOG® Implants before soft tissue closure. Fig. 8: When screw-retaining the zirconium dioxide implants, it is essential to avoid too high a torque. CASE STUDY
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