BIOMIMETIC ICEBERG SINGLE IMMEDIATE-LOAD IMPLANT

With the new BIOMIMETIC ICEBERG implant, Avinent has increased its range of surgical solutions to better adapt to all clinical situations.

The characteristics of the Iceberg design are ideal for restorations with implants and prostheses, respecting the biology of the hard and soft tissues and favouring their growth, in addition to the aesthetics. Its converging morphology in the transmucosal area, with no angles or sharp edges, allows the mucous membranes to grow over the titanium and form a seal, thus achieving the adjustment profile established when planning the case.

Clinical Case

We present the case of a 57-year-old patient who consulted the clinic for mobility in tooth 14. The examination and complementary tests revealed the tooth had a fractured crown that could not be reconstructed.

After the diagnostic stage the treatment plan was explained to the patient. This consisted of atraumatic extraction of tooth 14 and the placement of an Avinent Biomimetic ICEBERG immediate-load implant, the regeneration of the vestibular gap and a single immediate-load crown.

It was verified that there was sufficient basal bone to achieve good primary stability of the implant. The surgery was scheduled and colour records were taken for the preparation of the provisional in eggshell.

The surgery was performed under local anaesthesia, starting with the extraction of tooth 14 and meticulous curettage of the socket. It was verified that the vestibular plate was intact.

The bed was prepared for securing the implant in the palatine bone, thus achieving good primary stability, maintaining distance from the vestibular plate and leaving a gap that would later be filled with a xenograft.

A 4x11.5 mm Avinent BIOMIMETIC ICEBERG implant was chosen as the patient's vertical gum thickness was 4 mm, so it was possible to place the implant at bone level and achieve a seal with the soft tissues around the polished neck of the implant.

An insertion torque of 35 Ncm was achieved and, in the same surgical intervention, an antirotation titanium abutment was connected to the implant to construct a screw-mounted immediate-load provisional.

Using photopolymerisable composite flow (Tetric EvoFlow, Ivoclar Vivadent) the provisional was captured in the mouth, for improved fit.

At the same time, the desired emergence profile was modelled.

Prior to positioning the provisional crown, the vestibular gap was filled with a block xenograft to avoid the collapse of the vestibular plate, following the immediate-regeneration protocol.

Finally the screw-mounted provisional crown was placed at 35 Ncm and the chimney topped with Teflon and composite. The provisional enabled us to seal the graft area and provide support to the soft tissue.

In the post-load x-ray control it was verified that the three-dimensional position of the implant was as planned and thanks to the vestibular restorations and the stabilisation of the soft tissues, the emergence profile achieved was as expected.

The tapered, converging geometry of the neck of the Iceberg implant, and its whole prosthetic line, makes it possible to distance the implant-prosthesis connection from the bone level, maintaining the stability of the periimplant tissues and protecting the implant.

Using this type of implant enables the tissues to maintain a perfect seal and makes it possible to model the emergence profile right from the start of the surgery, improving the final aesthetic result of the restoration. For this purpose, it is very important to take into account the patient's gum type, with the final restorative stage in mind.