"CONSERVATIVE IMPLANTOLOGY", USE OF INTEGRAL CERAMIC IN THE COMPLETE REHABILITATION OF THE FRONT SECTOR

NumeriUno, 12: 4-6, 2012

The aim of this work was to evaluate the structural properties of integral ceramic both as regards conservative and implantoprosthetic rehabilitation; integral ceramic has till now been considered a highly aesthetic material but it has been little used for rehabilitations on implants.
Integral ceramic is now widely used for making prosthetic rehabilitations with a very high aesthetic value, it can be used for making crowns, facets and implantoprosthetic posts. One of the characteristics that distinguishes integral from traditional ceramic is that it allows prosthetic preparation at juxta-gingival level, thus avoiding the risk of seeing a dark area at sulcular level. Integral ceramic is also used for making posts on implants with excellent results also as regards the resistance to masticatory loads. This clinical case describes the rehabilitation of the upper front sector with integral prosthesis on implants and integral facets on natural posts.

The clinical case
The clinical case concerns a male patient aged 48 with agenesis of 12, 22 and ectopic canines (Fig. 1-2). The patient was motivated and wanted to solve his situation from both an aesthetic and a functional point of view. We therefore proposed orthodontic therapy to create sufficient space for inserting two Premium implants in position 13 and 23; it was also proposed to make facets on 11 and 21, facets on the two canines “transforming” them into lateral incisors and making two integral ceramics on the implants with an integral prosthetic post to reobtain the two canines, in order to rehabilitate the appearance of the front sector. Satisfied with the plan, the patient decided to start rehabilitation immediately, obviously beginning with a professional hygiene session, with instructions for maintenance and motivation. At the following control he appeared to have kept up the oral hygiene and was motivated, so it was decided to start the orthodontic therapy (Fig. 3).

A cephalometric tracing was used to obtain a complete view of the brachyfacial skeletal type and to check the cephalometric values. After the extraction of element 63 a fixed orthodontic treatment was carried out with the Ricketts technique, using springs with light compression to create the necessary space for inserting the implants. Next we inserted two Premium implants (Sweden & Martina) 3.30 x 100 and waited for their integration (Fig. 4).
During the osseointegration period the job of the orthodontic device was to maintain the space. When the osseointegration period was ended the orthodontic device was removed and the four front elements were prepared (Fig. 5); the impression was then taken at the same time as the impression on the implants with a transfer for open tray technique with perforations (Fig. 6).
For greater precision the articulation wax was registered with the facial arch.
A week after the impression we carried out the “untreated” test of the four facets and the test of the two integral posts with the respective crown in integral ceramic (Fig. 7). When the laboratory phase was completed the prosthetic products were cemented with an integrally adhesive system.
The patient was completely satisfied with the work done from both an aesthetic and a functional point of view (Fig. 8).