arturO martOS fOSeLa
the Fitting of Five Straumann® roxolid implants
in the maxillary anterior Sextant, using an immediate
the patient is a 50-years old Caucasian woman, non-smoker the x-ray exam revealed a destructive loss of bone contactand in a good general state of health. She had suffered in the teeth of the maxillary anterior sextant and the presencebreast cancer with infiltrating ductal carcinoma of the right of periodontal pockets in the posterior sector. moderate tobreast, which required the breast to be removed, chemo- severe periodontal disease was found in the upper maxil-therapy, radiotherapy as well as subsequent anti-estrogen lary. tooth mobility was diagnosed in teeth 11, 13, 21 andtherapy1. She is still undergoing anti-hormonal treatment up 22. there was no mobility in the teeth in the posterior sectorto the present day.
Oral and Dental Anamnesis
the patient underwent orthodontic treatment as an adoles- more conservative treatment using scaling and root planningcent. She has silver amalgam fillings in some teeth and wears was considered for the posterior sectors of the upper maxil-a maryland adhesive bridge for positions 12 and 14 with lary; in the anterior sextant, extraction of teeth 11, 13, 21supports on teeth 11, 13 and 15, and a zirconium structure and 22 and subsequent treatment with dental implants. wecemented to the lower maxilla (Figs. 1 – 3). the patient exhib- assessed the possibility of an immediate loading protocolited progressive adult periodontitis. She reported that inflam- in the event of sufficient primary stability of the implants thatmation caused by the periodontitis has become significantly were fitted. we used the CbCt scanner to assess morphol-worse in recent years.
ogy and the quantity of residual bone in the area to undergotreated. the decision was made to treat the patient withStraumann® roxolid bone level implants, Ø 3.3 mm, nC,Slactive 12 mm. a total of 5 implants were to be fitted, three
of which in post-extraction alveolar sockets 11, 21 and 22 torus that was removed was used for the regeneration of theand two more in positions 12 and 14.
extraction zone around tooth 13, where the most damagewas found. after fitting the implants, an nC open tray impres-
sion post with a short 16.5 mm guide screw was inserted into
the extractions were performed followed by curettage of the each one. Suturing was performed using tension-free suturesalveolar sockets. the mucoperiosteal flap was elevated in (Fig. 8).
order to inspect the entire length of the bone crest and toassess any possible dehiscence which may have occurred Immediate Prosthetic Procedureduring the surgical procedure. the implant bed of the post- we then proceeded to take a direct impression of the im-extraction area was prepared, and two new alveolar sockets plants using an individually fenestrated tray, which had beenwere created for the insertion of our five implants (Figs. 6, sterilized during preparation (Fig. 9). we used a heavy fluid7). a dental splint made of resin with lateral wings, which elastomeric material and single-impression technique. afterwas supported by the remaining teeth aided us in perform- taking the impression, the end caps were fitted onto the im-ing the surgical procedure. these wings prevented the splint plants (Fig. 10). the impressions were quickly sent to thefrom moving while the surgery was performed (Fig. 5). all dental laboratory which then made an immediate temporaryof the implants exhibited good primary stability and were prosthesis (Figs. 15, 16).
considered suitable for immediate loading. at the same timeas the implant surgery, a maxillary torus was removed from Laboratory Proceduretooth 15. no biomaterial or biocompatible membrane of any the implant analogs matching the impression posts werekind was required, as no dehiscence was observed during modified and the type-1 plaster impressions were removedthe surgery. However, the bony material harvested from the from their moulds. we used Straumann® nC temporary abut-
ments (Figs. 11, 12). for making the immediate temporary tact with the opposing dental arch. the patient was recom-prosthesis. the temporary abutments were created by the mended to eat only soft foods for the first few weeks, anddental laboratory technician. next, the structure used for the she was prescribed antibiotics and instructed to rinse with atemporary restoration was polished. Five hours later, the tem- chlorhexidine mouthwash as a precaution. the stitches wereporary abutments which had been made were sent back to removed ten days after the surgical procedure (Fig. 17).
the clinic along with the temporary prosthesis (Figs. 13 – 15).
Fitting the Temporary Structures
after a 12-week waiting period to allow osseointegration,
the prosthesis and abutments were sterilized and mounted the temporary restoration was removed and the progress ofonto the fitted implants. next, we cemented our temporary implant integration was assessed. all of the implants exhib-prosthesis into place, achieving a tailor-made restoration with ited a solid degree of osseointegration. the healing of thethe best possible appearance. we were able to restore our soft tissue was favorable (Fig. 18), allowing us to proceedpatient's smile in just 5 hours (Fig. 16). we avoided con- with the final restoration. temporary resin crowns had been
made for teeth 15, 24 and 25. we then proceeded to create teeth 14, 15 and 24 (Fig. 21). the final outcome of the resto-these teeth. the nC open tray impression posts were once ration is shown in fig. 22. Six months later, a follow-up x-rayagain fitted onto the implants, a final impression was made showed no sign of peri-implantitis and that all the implantsand the temporary restoration was cemented into place, were stable.
including the temporary crowns for teeth 15, 24 and 25(Figs. 19, 20). implant analogs were fitted, plaster casts were Conclusionsmade and the models were mounted onto the articulator to narrow diameter implants have always suffered from the dis-assess the inter-maxillary relationship. using the Straumann® advantage that they fracture under excessive loading. today,planning Kit, we selected permanent abutments, specifically this problem can be avoided by using Ø 3.3 mm Straumann®Straumann® multi-base abutments, angled at 25º (four type- roxolid bone level implants. both roxolid® (the material) anda, one type-b). two zirconium structures were made, one for Slactive® (the hydrophilic surface) facilitate excellent osseo-teeth 11, 12 and 13 and the other for teeth 21, 22 and 23, integration and flexible treatment with narrow diameter im-plus three independent crowns, also made of zirconium, for plants. they offer a greater variety of treatment options for
situations where bone preservation and blood supply are crucial and representa practicable solution in certain clinical situations, inspiring greater confidence inboth patients and professionals. in my opinion, it is the best implant for cases withnarrow bone crests and bone damage requiring bone augmentation for the fittingof larger diameter implants, which also involves the attendant stress of surgery.
we therefore see roxolid® implants as an excellent alternative for cases requiringmore complicated surgery where the problem of an insufficiently wide bone crest
Dr. Arturo Martos Fosela
could potentially endanger the feasibility of the reconstruction, while at the same
time avoiding greater surgical stress for the patient.
degree in medicine and Surgery. Specialist consultant
1 The carcinoma was removed on March 2007, solely treating the patient's breast tissue. The implant
in dentistry and oral Surgery, with broad experience
therapy was thus carried out in compliance with the indicated waiting period of 2 years between cancer
and training in dental esthetics and dental implant
treatment and implant surgery. As an alternative treatment, the patient was given Anastrozole (trade name
surgery. member of the Sociedad española de
Arimidex by AstraZeneca), which is a potent non-steroidal aromatase inhibitor. It is a highly selective and
potent drug from the fourth generation of this pharmaceutical class. Unlike aminoglutethimide – an aroma-
Cirugía bucal (the Spanish oral Surgery Society).
tase inhibitor from the earlier generation – Anastrozole does not inhibit the synthesis of adrenal steroids.
private practice since 1988.
Patients treated with Anastrozole do not require glucocorticoid or mineralocorticoid replacement therapy
and therefore have no contraindication for dental implant treatment in such cases.
THE UNITED REPUBLIC OF TANZANIA MINISTRY OF WORKS, TRANSPORT AND COMMUNICATION NATIONAL INFORMATION AND COMMUNICATIONS PRINTED BY THE GOVERNMENT PRINTER, DAR ES SALAAM-TANZANIA THE UNITED REPUBLIC OF TANZANIA MINISTRY OF WORKS, TRANSPORT AND COMMUNICATION NATIONAL INFORMATION AND COMMUNICATIONS
The ne w engl and journal of medicine A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women Paul M Ridker, M.D., Nancy R. Cook, Sc.D., I-Min Lee, M.B., B.S., David Gordon, M.A., J. Michael Gaziano, M.D., JoAnn E. Manson, M.D., Charles H. Hennekens, M.D., and Julie E. Buring, Sc.D. b a c k g r o u n d