Customised restoration of a single Biomimetic Iceberg post-extraction implant with tissue preservation (2)

As already explained in our blog in the first part of the case by Dr. Jesús López Vilagran “Single Biomimetic Iceberg immediate implant (18/03/2021)”, preserving the socket during the placement of an immediate post-extraction implant can compensate the socket remodelling process and promote bone formation. In addition, the use of an immediate provisional will, at the same time, help improve the final aesthetic results.

Prosthetic rehabilitation

In this case, an immediate provisional prosthesis was made using a customised titanium abutment screw-mounted to the implant. The impression was taken of the abutment and the acrylic provisional with flowable composite and the emergence profile was defined freely until an outlined crown was achieved that replicated the condition of the tissues prior to the extraction and maintained them during the healing period of the implant.

The following orthogonal slice shows the stabilised implant, the volume of the alveolar bone regenerated and the shaping of the tissue on the emergence profile of the provisional crown.

After a 3-month healing period, the provisional restoration was unscrewed and a digital impression of the emergence profile was taken immediately with a Trios (3Shape) scanner. A second scan was taken with a scan abutment screw-mounted onto the implant. The two scans were superimposed by the Dental System (3Shape) software so as to have all the information and to be able to proceed with the design of the definitive restoration.

It was decided to design a single restoration in zirconium on a customised Avinent titanium base. This type of interface makes it possible to perfectly customise both the emergence profile and the height of the cementing with the zirconium. These are common problems of standard interfaces, when it is necessary due to the type of case, and thus it is possible to replicate the emergence profile achieved with the provisional prosthesis that has been in the patient’s mouth for the preceding months.

As can be observed in the following sequence of images, the full volume of the crown was designed with Dental System (3Shape), and the restoration was then segmented into primary (gold titanium) and secondary (Ivoclar Prime Zirconium).

Once validated by the full-volume design, it was segmented with Blenderfordental, software that greatly simplifies the design of this type of work, with special attention in monitoring the titanium and zirconium thicknesses. Having performed the segmentation in this way, the design flows much more naturally than when we design the primary and then from this the secondary; we only need to pay attention to the final design of the crown as a whole and not in parts, which is much less intuitive.

In comparison with a standard titanium base, the customised design means the emergence profile has a perfect shape and a design that fits snugly with the implant shoulder.

One of the advantages of using a Biomimetic Iceberg implant in this case is that it makes it possible to distance the implant-crown union from the bone level, providing greater stability over time. In addition, the anodised neck of this model of implant enables camouflage and a better aesthetic effect at the level of the soft tissues.

Conclusion

According to the literature, from a biological point of view, preserving the socket in the placement of a post-extraction implant makes it possible to stabilise the marginal bone levels, making the survival of these implants comparable to those placed in fully healed crests.

The excellent response of the tissues in this case shows that the technique of immediate load and regeneration of the vestibular gap enables this soft tissue to be stabilised and the desired emergence profile modelled using the provisional prosthesis, transferring this outline to the definitive fully customised restoration.