Dental Asia Nov/Dec 2018

User Report DENTAL ASIA NOVEMBER / DECEMBER 2018 44 NobelActive ® Implants Raising the Standard of Aesthetic Dentistry for Over 10 years By Prof. Alessandro Pozzi, DDS, PhD Several studies and peer-reviewed publications confirm that NobelActive implants result in excellent clinical outcomes evenwith challenging indications and high aesthetic expectations. 1 This clinical case demonstrates excellent initial soft and hard tissue outcomes using the NobelActive implants which are preserved over the long term. Clinical case and overview In 2008, a patient presented a failing porcelain-fused-to-metal (PFM) fixed dental prosthesis on tooth numbers 24 and 25 (Fig. 1). Fig. 1: Pre-operative situation after the removal of the crowns. The clinical examinations showed periapical infection and root fracture at tooth 24; and gingival inflammation, bleeding on probing and 4 mm of periodontal probing depth on both teeth. The patient was in good medical condition and was concerned about the aesthetic outcomes of the treatment. After evaluation of the root dimensions and the available bone at the recipient site, immediate placement of a NobelActive implant after extraction of tooth 24 was planned and root canal treatment of tooth 25 was performed. Surgical Procedure Aminimallyinvasivetoothextraction,without elevating a gingival flap, was performed to maintain the integrity of the buccal plate and proximal bone peaks (Fig. 2). The height of residual bone was 7 mm. After a mechanical and chemical debridement, the alveolar socket was disinfected with rifampicinantibioticsolution. Asimultaneous transcrestalguidedsinusaugmentation 2 was performed to lift the sinus membrane and a NobelActive RP 4.3 × 13 mm implant was placed. Socket augmentation and autogenous soft tissue grafting were performed to close the socket and increase the amount of soft tissue at the recipient site. Fig. 2: Clinical view immediately after tooth extraction Fig. 4: Intraoperative view during implant insertion Fig. 3: Intraoperative view through the surgical template Four months later, a two-stage surgery and simultaneous implant impression with the delivery of a healing abutment was performed (Figs. 3-4). The implant stability quotient (ISQ) was 69, resulting from satisfactory engagement of the implant with the native bone surrounding the alveolar pocket. After four weeks, the implant was provisionalised with a screw-retained restoration. Furthermore, four weeks later, the final lithium disilicate crown was placed. The total treatment time, from the first consultation to the delivery of the final restoration, was six months. Results after 10 years Intraoral and radiographic examinations were performed at one, three, five, seven