Clinical
An instructor with the North of England Dental Academy, Richard Winter assesses the latest implant technology and offers his perspective on evolving techniques and components
restoration The art and science of
T
he patient is a 56-year-old fema le, who had lost the two upper right
premolar teeth some years previously. Her medical history was unremarkable. She was concerned about
the spacing and was inter- ested in replacing the teeth. A full assessment was undertaken and options discussed. A treatment plan was formulated, with the patient deciding on the use of implants in this case. The pre-operative assessment revealed good bone volume and quality. Two 13mm regular platform (4mm) TBR Connect implants were placed conventionally using a surgical guide from a diag- nostic waxing. A minimal flap surgical approach was used.
Primary insertion torque
was high, so a one-stage technique was employed, and healing abutments placed. (Fig 1). Healing progressed without any post-operative complica- tions, and 12 weeks were allowed for healing and integration. Figure 2 shows the implant
heads after 12 weeks, after removal of the healing abut- ments. Note the excellent soft tissue healing with the absence of signs of inflam- mation. Fixture head impressions
were taken using a pick-up technique, making use of the Swiss Clip, a closed tray impression coping produced by TBR. This coping has an excellent seating system, utilising a silicone ring that engages the internal contour of the implant beyond the internal hexagon (Fig 3). This gives a very firm
and positive feel with no ambiguity when the coping is engaged correctly (Fig 4). The design and construc- tion allows for a high degree of accuracy, linked with the ease of placement.
Impressions were then
taken using a heavy bodied/ wash one-stage technique using a rimlock metal tray (Fig 5). An opposing model and a silicone recording of ICP was also taken in the usual way The laboratory stages
were carried out by PDS laboratories (Leeds, UK). The restorative compo- nents were made on a soft tissue model (Fig 6). The custom fabricated titanium abutments were tried in
Continued ››
“This coping has an excellent seating system, utilising a silicone ring that engages the internal contour of the implant beyond the internal hexagon”
Fig 1 Abutments in position
Fig 2 Implant heads at 12 weeks
Fig 3 Fixtures
Fig 4 ‘High degree of accuracy’
Scottish Dental magazine 59
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