Simultaneous sinus floor lift and placement of a metal-free implant
Dr. Jens Tartsch
Switzerland
“Because of the tapered design of the implant body and geometry of the threads, NobelPearl™ can be used in the rehabilitation of a broad range of indications, from single-tooth restoration to more challenging cases such as simultaneous sinus lift and implant placement, where high primary stability is required.”
Patient: 35-year-old, female, good general and oral health
Clinical situation: tooth 26 removed 2 years before rehabilitation
Surgical solution: NobelPearl™ Tapered RP 4.2 mm x 10 mm
Restorative solution: NobelPearl Abutment Straight Inter-X RP 1 mm with monolithic zirconia crown
Surgery date: December 2017
Tooth position: 26 (FDI system)
Total treatment time: 4 months
Initial clinical situation
Healed site 2 years after extraction of tooth 26. Note the lateral (left) and vertical (right) bone remodeling.
Treatment planning
Presurgical digital volume tomography (DVT) shows the vertical bone remodeling 2 years after extraction of tooth 26.
Treatment planning
Flap opening and surgical site preparation (left).
Sinus window preparation and access to maxillary sinus (center).
Sinus floor elevation (right).
Surgical procedure
Inserting the NobelPearl Tapered Ø 4.2 mm x 10 mm implant (letf).
Implant inserted 0.6 mm supracrestal (center).
Sinus filled with deproteinized bovine bone (right).
Surgical procedure
Horizontal augmentation using deproteinized bovine bone (left).
Bone substitute covered with resorbable collagen membrane (center).
Primary wound closure (right).
Restorative procedure
The re-entry took place 3 months after implant insertion with small crestal incision. Healthy soft tissue 2 weeks after re-entry around the gingiva cap (left).
Placing the NobelPearl Impression Coping Closed Tray Inter-X onto the implant (right).
Restorative procedure
NobelPearl Impression Coping Closed Tray Inter-X and lab Replica Inter-X (left).
Repositioning of the NobelPearl Impression Coping Closed Tray Inter-X in the impression material with the NobelPearl Implant Replica Inter-X and making sure that it is fully seated (right).
Restorative procedure
NobelPearl Abutment Straight Inter-X placed on the master cast with gingiva mask (left).
Monolithic zirconia crowns placed on the master cast (right).
Restorative procedure
Healthy and thick keratinized peri-implant mucosa seen following removal of the NobelPearl Healing Abutment Inter-X 4 months after surgery.
Restorative procedure
Try-in of the NobelPearl abutment (left).
Abutment in situ, with VICARBO® screw torqued 25 Ncm (right).
Restorative procedure
After restoration was cemented to the abutment intraorally, it was taken out of the mouth for cleaning (left).
Final insertion of the restoration with ratchet and torque 25 Ncm (right).
Restorative procedure
Restoration after installation and closing the screw access hole with Teflon.
Restorative procedure
Final restoration after screw access hole closed with composite.
Outcome
X-ray 3 months after implant insertion before loading (left).
1-year follow-up after loading. X-ray radiography shows excellent bone level preservation (right).
Outcome
Note the healthy mucosa without any signs of inflammation after removing the crown for control at 1-year follow-up (left).
1-year follow-up. Esthetic excellence with zirconia final restoration and very healthy soft tissue (right).
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NobelPearl™Unique metal-free, two-piece ceramic dental implant solution. An evolution of ceramic implants.
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© Nobel Biocare Services AG, 2019. All rights reserved. NobelPearl™ distributed by: Nobel Biocare. Legal manufacturer: Dentalpoint AG, Bodenäckerstrasse 5, 8957 Spreitenbach, Switzerland. VICARBO and ZERAFIL are trademarks of Dentalpoint AG. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. For prescription use only. Caution: Federal (United States) law restricts this device to sale by or on the order of a licensed clinician, medical professional or physician. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions. Nobel Biocare does not take any liability for any injury or damage to any person or property arising from the use of this clinical case. This clinical case is not intended to recommend any measures, techniques, procedures or products, or give advice, and is not a substitute for medical training or your own clinical judgement as a healthcare professional. Viewers should never disregard professional medical advice or delay seeking medical treatment because of something they have seen in this clinical case. Full procedure is not shown. Certain sequences have been cut.