Implant planning with Galimplant 3D Exacto, use of threaded osteotomes and immediate placement of the definitive abutments

Dr. Jesús Pato Mourelo

Diagnosis and planning

In recent years, technological and scientific advances have revolutionized the world of dentistry, due to the credibility achieved by osseointegration.

These advances improve surgical procedures, along with precision in implant placement and the demand for excellent aesthetic and biological results. Planning plays a key role in the overall treatment.

Guided surgery allows the planning of virtual implants in the data set provided by three-dimensional CT scans, allowing an exact predetermination of treatment and the transfer of rehabilitation planning to the operative field.

The objective of this clinical case is the rehabilitation of a patient with partial mandibular edentulism at 45 and 46, with the placement of two dental implants, using a surgical guide for initial drilling and later the use of an osteotomy.

A.M.R 40-year-old female, partially edentulous, non-smoker, with no relevant medical history. The patient was evaluated radiologically with a cone beam computed tomography and her case was planned using the Galimplant 3D Exacto® computer system. Two 4X10mm galimplants (IPX 4010) were planned.

Surgical guide and drilling sequence

Once the planning of the two implants has been carried out, the impression of the dental-supported surgical splintis carried out with two cylindrical holes adapted to the 2-millimeter diameter pin drill. This drill has the function of three-dimensionally guiding the implant position.

Subsequently, the surgical guide is removed and drilling is performed with the Stop drill, 2 mm in diameter and 14 mm in length, directly on the implant beds. This drill will create the ideal implant bed (2mm infra-bone) since the mucosal thickness in this case is 2mm.

Sequence with osteotomes

After performing the anterior drilling, the following sequence consists of the progressive introduction of the osteotomes from smaller to larger diameter (1 and 2), until the necessary bone expansion and compaction are achieved for the insertion of the planned implants.

Placement of implants and prosthetic components

Once bone expansion has been performed, the two Galimplant implants with a diameter of 4 mmand a length of 10 mm (IPX 4010). These implants are grade IV titanium with an 11 degree conical connection. Once the implants have been placed, we remove the implant holder with a mosquito and insert 2 multi-position straight aesthetic abutments 3mmheight (MUSR04030)

Theimmediateplacement of these abutments is essential for obtaining results. optimal. Not only is it necessary for the implant to be integrated, but an optimal relationship between the implant connection, the prosthetic abutment and a good biological seal is also necessary, which, in many cases, it is altered by the connection and disconnection of different abutments during the osseointegration and restoration phase of the implant.

When an implant is placed, three types of epitheliumare created: oral, peri-implant, and peri-implant sulcus. The mucosa around the implant creates a seal very similar to the natural tooth; however, the biological width is increased (approximately 3 to 4 mm). The cells Epithelial cells bind to the titanium surface in a similar way to how epithelium binds to the tooth surface. The epithelium has a rapid proliferation, growing on the surface of the fibril that is deposited immediately on the prosthetic attachment; which, once contacted with the prosthetic abutment, moves in a corono-apical direction, originating the junction epithelium of approximately 2 mm, joining the surface through hemidesmosomes in the first days after surgery.

When we place an implant, the surrounding soft tissues create a barrier in the form of first fixation to the implant surface that blocks the entry of bacteria and oral toxins into the space between the implant and biological tissues, sealing the region.

The immediate placement of the prosthetic abutment at the same time of surgery and without disconnections, maintains the biological seal intact at all times, obtaining better results. In addition, the use of an aesthetic straight multi-position abutment makes the tooth-abutment interface more distant from the implant-bone contact point. This results in the removal of the inflammatory infiltrate from the connective tissue of the marginal bone crest. This platform change keeps the bone distant from the implant platform minimizing peri-implant marginal bone loss.

Conclusion of the clinical case

Find out about our products

Información productos