The art and science of restoration
The patient is a 56-year-old female, 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 interested 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 diagnostic 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 complications, and 12 weeks were allowed for healing and integration.
Figure two shows the implant heads after 12 weeks, after removal of the healing abutments. Note the excellent soft tissue healing with the absence of signs of inflammation.
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 construction 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 components were made on a soft tissue model (Fig 6). The custom fabricated titanium abutments were tried in and verified with an acrylic jig (Figs 7 and 8). Checks were made for occlusal clearance and the position of the margins. No adjustment was deemed to be necessary. Porcelain bonded to precious metal linked crowns were then constructed (Fig 9). At the fit appointment, the crowns were tried in and the occlusion checked using foils and shimstock.
Retaining adjacent contacts were maintained with light holding contacts in ICP. Lateral guidance was by group function, and the replacement crowns were designed so as not to be involved in this. After approval by the patient, the crowns were fitted (Figs 10 and 11), again note the excellent soft tissue profile and healthy appearance. The screw access holes in the abutments were covered with cotton wool and Cimpat (Septodont), with the crowns being secured using a soft cement (Temp-Bond, Kerr).
The patient was reviewed a week later, and instructed in maintaining the prostheses. She was naturally delighted with the finished result, with any initial trepidation being replaced with both relief and surprise at the relative ease of the treatment.
This case report describes the restoration of two premolar teeth using a new implant system to the UK, TBR implants. TBR has been involved in the European market for some years, and has recently been introduced to the UK by Implants UK. Its UK supplier is Prestige Dental. It produces a range of implants, all of which are tapered and threaded. They utilise a tapered internal hexagon connection, which combines the benefits of flexible abutment alignment with the comprehensive seal that a morse taper provides.
This case demonstrates well the predictability that implant treatment can provide, and the ease of use of the new TBR restorative components. The Swiss clip especially, is a simple component that is user-friendly and provides a highly accurate reproduction of the position of the implant head.
About the author
Richard Winter BDS, MJDF (RCS Eng) is a GDP with an interest in implant and restorative dentistry. Currently based in Newcastle upon Tyne, he works at two established private practices where he takes referrals for implant and restorative treatment. He is tutor for the Northern Region FGDP, and an instructor with the North of England Dental Academy, which runs year-long post graduate courses in restorative, implant and aesthetic dentistry.
To see all the clinical photographs from this article, visit our Facebook page by clicking here.