logo 49 | The Camlog Partner Magazine 18 | Case study Guided Surgery – minimally invasive, scar-free, tissue preserving PRACTICE CASE “The ultimate goal of long-term stable implant therapy, besides patient satisfaction, is an esthetic and durable reconstruction. Anatomical preservation of the peri-implant tissue structures is paramount. Perfectly coordinated communication between the surgeon, prosthodontist, dental technician and patient is the key to success here. Optimal pre-surgical 3D planning and minimally invasive guided surgery help achieve these goals predictably with immediate implant placement in the anterior region, provided certain criteria are met and the facial lamellae are largely intact. Dr. Christoph Schmidtner Dentist Dr. Christoph Wenninger Dentist If a tooth that cannot be preserved has to be extracted in the esthetic region, then immediate implant placement should be taken into consideration. Here, it is imperative to consider any complications that may arise vis-à-vis the potential biological compromises associated with delayed implantation. These could include surgical reconstruction of the resorbed buccal bone lamella as well as thickening of the soft tissues. An immediate implant can largely preserve the surrounding tissue structures, provided that the buccal alveolar wall is intact or that only minor bone defects are present, that the tooth socket is free of inflammation and that there is sufficient bone in the apical region for the primary stable anchorage of a sufficiently long implant. The patient’s wish for a temporary immediate restoration must be balanced in line with the functional load. If, for example, therapy-resistant parafunctions occur, then immediate loading is an increased risk for osseointegration of the implant. The macrodesign of the implant system as well as the structural and auxiliary components matching this concept are essential for the success of immediate implantation. In the case described in the following, the CAMLOG® PROGRESSIVE-LINE implant was selected. In addition to the quality of the implant bed preparation, the thread flanks, which penetrate deeply into the alveolar bone, and the apically tapered implant body meet the requirements for immediate restoration protocols. The precise Tube-in-Tube® internal configuration eliminates micromovements to a large extent and the platform switching option allows creating sufficient space for the soft tissue cuff. Correct, positionally stable insertion of the implant can be achieved with the aid of a drilling template created on the basis of 3D planning. The guidance of the drills in the template ensures accurate axial implant bed preparation without any lateral deviation. This prevents an undesired change in direction of the drills and the inserted implants. In addition, the drilling protocol which is adapted to different bone qualities leads to achieving predictable primary stability. Minimally invasive surgery following tooth extraction reduces surgical trauma due to flapless surgery, implant placement without creating flaps, and shorter times for surgery. Associated postoperative symptoms, such as swelling or pain, are also minimized. Particularly in surgical practices with a referral structure, immediate restoration concepts should be discussed in detail by the treatment team, consisting of surgeons, prosthodontists, dental technicians and also the patients, to avoid any misunderstandings and to understand the different expectations. However, the correct digital positioning of the implant always remains the responsibility of the implantologist. He/she will plan the prosthetically oriented placement based on a digital or digitized wax-up. It is advantageous to realize manufacturing of the tooth-supported drilling template as in the present case within a short space of time between the scan and implantation. Due to possible loose teeth or tooth migration, this increases the accuracy of the template fit and subsequently of insertion and contributes to therapeutic safety.
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