internal hex- case study - the future of dental implants reports/case study... · dental practice...

Internal Hex- Case Study

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Dr. Meir Mamraev, DMD,. LLB,. (Israel) Graduated from Dental school of Iasi University in 1992 and Law school of Ono College in 2005.

One of the founders of Cortex company. Senior Vice President of research and Development at Cortex dental implants industries LTD. Head of postgraduate training programs and academical activities of Cortex. Worldwide lecturer as well as an owner of a private dental practice in Tel-Aviv, Israel.

Dr. Ricardo Velazquez (Mexico) Graduated with Honors at University of MexicoUNAMInternational Team of Implantology Member Mexican Oral and Maxilofacial ImplantologyCollege Member Advanced Implant Therapy . School of Dentistry.UCLA. Los Angeles. CA All on 4 Dental Implant Rehabilitation. BaylorCollege of Dentistry. Dallas . Tx

Implantology Private practice since 2001

CASE 1Page 4

CASE 2Page 6

CASE 3Page 8

CASE 4

Page 12

INDEX

CASE 6

CASE 9

CASE 10Page 22

CASE 11Page 24

CASE 12Page 26

CASE 13Page 28

CASE 1Page 18

CASE 8

CASE 7Page 16

CASE 5

Page 10

Page 20

Page 14

4

CASE 1

Diagnostics

Age: 65 Gender: Female

Tooth: #22 root fracture

Non-Smoker

Dr. Meir Mamrav, Israel

5

CASE 1 Treatment Plan

Tooth #22 Extraction and immediate Implant placement and immediate loading with provisional crown.

Operation

Operation Date: 03.09.2011

Tooth #22 Extraction and implant placement with provisional cemented crown.

Chosen Implant: Position 22: Ø3.8 / 16mm - Dynamix

Clinical Follow-Up

1. Follow Up Date: 13.09.2011Patient had no pain, no swelling of gingiva and failure of osseointegration of theimplant.

2. The follow-up check dental X-ray of 3 years and 6 months after implant placementshows no marginal bone resorption and progressive bone healing of the extractionalveoli.

Conclusion

There were no signs of peri-implantitis around the implants on 3 year and 6 months after implant placement, no fibrosis, and bone loss value.

The bone integration around the implant progressed according to plan without fatty infiltration, granuloma, etc.

6

CASE 2

Diagnostics


Teeth: #24, #32, #42, #44, #45, #46

Non-Smoker


7


Teeth: #32-#42 Extraction and immediate Implant placement and immediate loading with provisional crown. Missing teeth rehabilitation with dental implants.

Operation Operation Date: 25.02.2010

Tooth: #24 implant placement with healing cap. Teeth: #32-#42 implant placement after extraction with provisional restoration. Teeth: #44, #45, #46 implant placement with healing caps

Chosen Implants: Position 24: Ø3.8 / 13mm - Dynamix Position 32: Ø3.8 / 13mm - Dynamix Position 42: Ø3.8 / 13mm - Dynamix Position 44: Ø4.2 / 11.5mm - Dynamix Position 45: Ø4.2 / 10mm - Dynamix Position 46: Ø4.2 / 11.5mm - Dynamix

Clinical Follow-Up

1. Follow Up Date: 25.02.2010Patient had no pain, no swelling of gingiva and failure ofosseointegration of the implant.

2. The follow-up check dental X-ray of 5 years and 2 months afterimplant placement shows no marginal bone resorption andprogressive bone healing of the extraction alveoli.

Conclusion


The bone integration around the implant progressed according to plan without fatty infiltration, granuloma, etc

8

CASE 3

Diagnostics


Teeth: #17, #16, #25, #26, #27, #33, #34, #35, #37, #43, #44, #45, #47

Missing teeth upper jaw.

Severe advanced periodontitis, teeth mobility grade III. Missing teeth. Class III lower jaw

Non-Smoker


9


Total clearance and rehabilitation with fixed restorations with immediate loading lower jaw. Rehabilitation of missing teeth on upper jaw with implants and fixed restorations.

Operation


Implants placement, flapless on upper jaw, 1 stage


Extractions lower jaw, implants placement and immediate loading with cemented temporary bridge.

In lower jaw were performed bone augmentation with membrane barrier from collagen

Chosen Implants: Position 17: Ø4.2 / 11.5mm - Dynamix Position 34: Ø3.8 / 13mm - Dynamix Position 16: Ø3.8 / 11.5mm - Dynamix Position 33: Ø3.8 / 11.5mm - Saturn Position 25: Ø3.8 / 13mm - Dynamix Position 43: Ø3.8 / 11.5mm - Saturn Position 26: Ø4.2 / 11.5mm - Dynamix Position 44: Ø3.8 / 11.5mm - Dynamix Position 27: Ø4.2 / 11.5mm - Dynamix Position 45: Ø4.2 / 11.5mm - Dynamix Position 37: Ø3.8 / 11.5mm - Classix Position 47: Ø3.8 / 11.5mm - Classix Position 35: Ø3.8 / 11.5mm - Classix

Clinical Follow-Up

1. Follow up session 1 week post-op for suture removing.

2. Follow up every month after the surgery for clinical evaluation until thestage of prosthetic rehabilitation.

3. The follow-up check dental X-ray of 3 years and 6 month after implantplacement shows no marginal bone resorption and progressive bonehealing of the extraction alveoli.

Conclusion

There were no signs of peri-implantitis around the implants on 3 years and 6 after implant placement, no fibrosis, and bone loss value.


10

CASE 4

Diagnostics

Age: 54 Gender: Male

Teeth: #17, #16, #15, #13, #12, #22, #23, #25, #26, #27 #37, #36, #35, #34, #32, #42, #44, #45, #46, #47

Severe advanced periodontitis, multiple missing teeth, malocclusion.

Non-Smoker


11


Total clearance of remaining teeth, temporesation with removable dentures, and rehabilitation with cemented bridges.

Operation


Extraction of remaining teeth, alveoloplasty, implant placement and removable dentures balance and relining.

Chosen Implants: Position 17: Ø5.0 / 10mm - Classix Position 37: Ø4.2 / 13mm - ClassixPosition 16: Ø4.2 / 13mm - Classix Position 36: Ø4.2 / 13mm - ClassixPosition 15: Ø3.8 / 11.5mm - Classix Position 35: Ø4.2 / 13mm - ClassixPosition 13: Ø3.8 / 11.5mm - Classix Position 34: Ø4.2 / 13mm - ClassixPosition 12: Ø3.8 / 13mm - Classix Position 32: Ø3.8 / 13mm - ClassixPosition 22: Ø4.2 / 13mm - Classix Position 42: Ø3.8 / 13mm - ClassixPosition 23: Ø3.8 / 11.5mm - Classix Position 44: Ø3.8 / 13mm - ClassixPosition 25: Ø3.8 / 11.5mm - Classix Position 45: Ø3.8 / 13mm - ClassixPosition 26: Ø3.8 / 11.5mm - Classix Position 46: Ø3.8 / 13mm - ClassixPosition 27: Ø5.0 / 10mm - Classix Position 47: Ø3.8 / 13mm - Classix

Clinical Follow-Up

1. Follow Up Date: 27.08.2008Sutures removal and denture relining. Patient had no pain, noswelling of gingiva and failure of osseointegration of theimplant.

2. The follow-up check dental X-ray of 5 years and 6 monthsafter implant placement shows no marginal bone resorptionand progressive bone healing of the extraction alveoli.

Conclusion

There were no signs of peri-implantitis around the implants on 5 years and 6 months after implant placement, no fibrosis, and bone loss value.


CASE 4

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CASE 5

Diagnostics

Age: 57 Gender: Male

Teeth: #46 fractured, #47 missing

Non-Smoker


13


Tooth #46 extraction and immediate Implant placement position 47.

Operation


Tooth #46 extraction and immediate Implant placement position 47.

Chosen Implant: Position 46: Ø6 / 11.5mm - Dynamix Position 47: Ø6 / 11.5mm - Dynamix

Clinical Follow-Up

1. Follow Up Date: 13.09.2011Patient had no pain, no swelling of gingiva and failure of osseointegrationof the implant.

2. The follow-up check dental X-ray of 3 years and 6 months after implantplacement shows no marginal bone resorption and progressive bonehealing of the extraction alveoli.

Conclusion



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CASE 6

Diagnostics


Tooth: #13, #14, #15 decay

Non-Smoker


15


Teeth: #13, #14, #15 extraction and immediate Implant placement and immediate loading with provisional crown.

Operation


Teeth: #13, #14, #15 Extraction and implant placement with provisional cemented crown.

Chosen Implants: Position 13: Ø3.8 / 13mm – Dynamix Position 14: Ø3.8 / 13mm – Dynamix Position 15: Ø4.2 / 10mm – Dynamix

Clinical Follow-Up

1. Follow Up Date: 10.03.2010Patient had no pain, no swelling of gingiva and failure ofosseointegration of the implant.

2. The follow-up check dental X-ray of 5 years and 6 months after implantplacement shows no marginal bone resorption and progressive bonehealing of the extraction alveoli.

Conclusion



16

CASE 7

Diagnostics

Age: 63

Gender: Female

Teeth: #36, #46 Missing

Non-Smoker


17


Teeth: #36, #46 implant placement.

Operation Operation Date: 03.09.2010 Implant placement.

Chosen Implants: Position 36: Ø3.8 / 13mm – Dynamix Position 46: Ø3.8 / 13mm – Dynamix

Clinical Follow-Up

1. Follow Up Date: 05.03.2015 Patient had no pain, no swelling of gingiva and failure of osseointegration of the implant.

2. The follow-up check dental X-ray of 4 years and 6 months after implant placement shows no marginal bone resorption and progressive bone healing of the extraction alveoli.

Conclusion There were no signs of peri-implantitis around the implants on 4 year and 6 months after implant placement, no fibrosis, and bone loss value. The bone integration around the implant progressed according to plan without fatty infiltration, granuloma, etc.

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CASE 8

Dr. Ricardo Velazquez, Mexico

Diagnostics

Age: 58 Gender: Female Tooth: #11, #12, #21, #22 Dx. External root Reabsortion #11, #12,#21, #22 Root Fracture #21, #22 Non-smoker.

19

CASE 8 Treatment Plan Flap Less Extraction #11, #12, #21, #22. Immediate implant placement and GBR

Operation Operation Date: 15.05.2017 Chosen Implant: Position 11: Ø3.3/ 11.5mm – Dynamix Position 12: Ø3.3/ 11.5mm – Dynamix Position 21: Ø3.3/ 11.5mm – Dynamix Position 22: Ø3.3/ 11.5mm – Dynamix

Note: A non Cortex implant failed was removed at #15 position, and after healing a Cortex Dynamic implant.

Clinical Follow-Up 30/01/2019 No gum retraction, no papila loss, no pain, no swelling, no screw Loss, no bone loss Conclusion Esthetic implant outcome is predictable in cases where bone and soft tissues are adequate as long as correct planning is made, including a correct implant choosing an 3d implant position is mandatory a precise surgical and prosthetic. Manage to secure a good long-term prognosis

20

CASE 9


Diagnostics

Age: 60 Gender: Male Position #12, #14, #16, #22, #24, #25, #26 Diagnose : Failed Implants. Tooth mobility bone loss

Heavy Smoker

21

CASE 9 Treatment Plan Extraction failed Mal positioned Implants Extraction tooth #11, #21, #18 Bilateral sinus lift Immediate Implant Placement and GBR

Operation Operation Date: 04.11.2018 Chosen Implant: Position 12: Ø3.8/ 10mm – Dynamix Position 14: Ø4.2/ 11.5mm – Dynamix Position 16: Ø4.2/ 11.5mm – Dynamix Position 22: Ø3.3/ 13mm – Dynamix Position 24: Ø3.3/ 11.5mm – Dynamix Position 25: Ø5.0/ 11.5mm – Dynamix Position 26: Ø5.0/ 10mm – Dynamix Prosthetic Plan: 2 stages .Screw Retained PFM

.

Clinical Follow-Up

05/03/2019 - No sinusitis, no implant mobility 28/03/2019 - No bone Loss

The implant neck Dynamix design and the cover screw as well as a free flap, allow us a primary closure, a key factor for regeneration cases. The self-cutting Dynamix design give us a primary implant stability and the 5 moths x ray show us a good bone regeneration as well as sinus augmentation with no problems. Conclusion An implant which can provide a good primary stability like Dynamix by Cortex with the self-cutting design, is an essential requirement specially in type IV bone and bone regeneration cases like sinus lift cases. Even when Smoking is a Risk factor for Implant therapy is not an Absolut Contraindication. The patient must be informed about the risk and do it with an informed consent

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CASE 10


Diagnostics

Age: 70 Gender: Female Position #33, #36, #43, #46, Diagnose : Periodontitis, mobility, cavities and bad prognosis in the remaining tooth

Non-Smoker Diabetic Visual discapacity

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CASE 10 Treatment Plan 2 Stage approach:

1. Teeth extraction, implant and cover screw 2. Healing and impression

Operation Operation Date: 04.02.2015 Chosen Implant: Position 33: Ø4.2/ 13mm – Dynamix Position 36: Ø4.2/ 10mm – Dynamix Position 43: Ø4.2/ 11.5mm – Dynamix Position 46: Ø4.2/ 10mm – Dynamix Prosthetic Plan: Screw Retained Hybrid Prosthesis

Clinical Follow-Up

Follow up date: 28.03.2019 No bone Loss No screw loss No peri implanter disease Conclusion All on 4 fixed prosthesis is a well-documented option for a total mandibular rehabilitation. The implant selection with a good initial stability and a proper planning and 3d position is mandatory for a long-term prognosis. Screw retained prosthesis is a must in order to give a maintenance.

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CASE 11


Diagnostics

Age: 58 Gender: Female Position #16, #17, #24, #25, #26, #36, #45, #46 Absence teeth ·#16·#17 Fixed bridge replaced with individual dental implants

Non-Smoker

25

CASE 11 Treatment Plan 2 Stage approach. Operation Operation Date: 26.12.2014 Chosen Implant: Position 16: Ø4.2/ 11.5mm – Dynamix Position 17: Ø5.0/ 10mm – Dynamix Position 24: Ø4.2/ 11.5mm – Dynamix Position 25: Ø4.2/ 10mm – Dynamix Position 26: Ø4.2/ 13mm – Dynamix Position 36: Ø4.2/ 11.5mm – Dynamix Position 45: Ø4.2/ 11.5mm – Dynamix Position 46: Ø4.2/ 11.5mm – Dynamix Prosthetic Plan: Single Screw-Retained zyrconia crown

Clinical Follow-Up

Follow-up date: 28.11.2019 No bone loss No screw loss No peri implanter disease Conclusion Dental Implant therapy is a very good documented alternative to substitute dental bridge to getting better for cleaning and long-term prognosis as well as improving aesthetics.

26=

CASE 12


Diagnostics

Age: 60 Gender: Female Position #13, #14, #22, #23, #24, #26, #27

Dx. mobility and loss of buccal plate and gum recession #22, #23 Root fracture #13, #14 Nonsmoker Controlled Diabetic

27=

CASE 12 Treatment Plan Extraction #22, #23, #13, #14 Immediate implant placement and GBR Operation Operation Date: First stage - 02.02.2019 Chosen Implant: Position 13: Ø4.2/ 11.5mm – Dynamix Position 14: Ø4.2/ 11.5mm – Dynamix Position 23: Ø3.3/ 11.5mm – Dynamix Position 24: Ø3.8/ 13mm – Dynamix Position 26: Ø4.2/ 11.5mm – Dynamix Second stage – 13.05.2019 Position 22: Ø3.8/ 11.5mm – Dynamix Position 27: Ø5.0/ 11.5mm – Dynamix Prosthetic Plan: CAD/CAM Screw Retained PMMA Temporaries Screw-Retained PFM Bridge Notes: an innovative scan impression was made with scan analog scanning to made the PMMA temporaries and overlapping with the mockup in order to have the final esthetic temporary bridge and scanned with scan analogs to obtain the final emergence profile and pontics.

Clinical Follow-Up

Follow-up date: 03.09.2019 No pain, no mobility, no gum recession, and excellent soft and hard tissues volume as a result of the previous GBR treatment Conclusion Different Digital workflow approaches could be used to solve implant cases in order to offer a faster and more accurate treatment to the patients. The selection of a proper dental implant as Dynamix Cortex is mandatory especially for bone type 3 and 4 in order to get a successful long-term result.

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CASE 13


Diagnostics

Age: 53 Gender: Female Position #21

Tooth loss after fall accident ·#21 Nonsmoker

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CASE 13 Treatment Plan 2 stage implant placement #21 and GBR Operation Operation Date: 20.05.2016 Chosen Implant: Position 21: Ø3.3/ 11.5mm – Dynamix Prosthetic Plan: Partial removable provisional denture and after 3 months screw-retained PFM crown #21 and feldspathic veneers #11, #12, #22

Clinical Follow-Up

Follow-up date: 20.09.2019 No gum retraction, no bone loss, no papillae recession, no pain, no screw loose. Conclusion Two stage implant placement surgery is a good option, especially in some cases when GBR is needed. Choose an implant that can offer good initial stability is mandatory especially in cases with limited bone quality and or quantity.

[email protected] www.cortex-dental.com

internal hex- case study - the future of dental implants reports/case study... · dental practice...

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