{"id":6013,"date":"2021-04-29T08:49:22","date_gmt":"2021-04-29T06:49:22","guid":{"rendered":"https:\/\/blog.avinent.com\/?p=1343"},"modified":"2024-11-13T09:34:31","modified_gmt":"2024-11-13T08:34:31","slug":"restoration-of-lateral-incisor-agenesis-with-reduced-diameter-implants","status":"publish","type":"post","link":"https:\/\/avinent.com\/en\/blog\/restoration-of-lateral-incisor-agenesis-with-reduced-diameter-implants\/","title":{"rendered":"Restoration of lateral incisor agenesis with reduced diameter implants"},"content":{"rendered":"\n\t\t\t\t\n<p><strong>Introduction<\/strong><\/p>\n\n\n\n<p>One of the\nsituations we face in our daily practice is limited interdental mesio-distal\nspace that hinders the placement of standard metric implants. <\/p>\n\n\n\n<p>To solve\nthis problem and avoid having to resort to dental-supported fixed prostheses or\nremovable prostheses, nowadays we have the possibility of using reduced\ndiameter implants that, as we will see below, are an excellent tool for cases\nin which the distribution of space is our main difficulty.<\/p>\n\n\n\n<p><strong>Clinical case<\/strong><\/p>\n\n\n\n<p>Female patient aged 16 years consults the\nclinic for agenesis of the upper lateral incisors 12 and 22. The patient had no\nprior medical history of interest and the x-ray and clinical examination\nrevealed excellent oral health. We referred her to the orthodontist who, after\nthe pertinent study, started treatment with braces to try to gain maximum space\nbetween the central and canine teeth with the aim of placing two implants in\nfuture.<\/p>\n\n\n\n<p>After two years of orthodontic treatment, the\npatient&#8217;s the situation was reevaluated and it was decided to wait\napproximately one more year before placing the implants. The reason was to\nensure the full development of the patient&#8217;s maxillary bone.<\/p>\n\n\n\n<ul class=\"wp-block-gallery columns-3 is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"500\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/1-2-2.jpg\" alt=\"\" data-id=\"1350\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1350\" class=\"wp-image-1350\" srcset=\"https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/1-2-2.jpg 800w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/1-2-2-300x188.jpg 300w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/1-2-2-768x480.jpg 768w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/1-2-2-180x113.jpg 180w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/1-2-2-360x225.jpg 360w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/1-2-2-640x400.jpg 640w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption>Patient&#8217;s initial CT scan after orthodontic treatment<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" width=\"800\" height=\"500\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/2-2-2.jpg\" alt=\"\" data-id=\"1351\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1351\" class=\"wp-image-1351\" srcset=\"https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/2-2-2.jpg 800w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/2-2-2-300x188.jpg 300w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/2-2-2-768x480.jpg 768w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/2-2-2-180x113.jpg 180w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/2-2-2-360x225.jpg 360w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/2-2-2-640x400.jpg 640w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption>Patient&#8217;s initial CT scan after orthodontic treatment <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/3-2.jpg\" alt=\"\" data-id=\"1352\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1352\" class=\"wp-image-1352\" \/><figcaption>Patient&#8217;s initial CT scan after orthodontic treatment <\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-gallery columns-3 is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/4-1.jpg\" alt=\"\" data-id=\"1356\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1356\" class=\"wp-image-1356\" \/><figcaption>STL images for planning<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/5-1.jpg\" alt=\"\" data-id=\"1357\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1357\" class=\"wp-image-1357\" \/><figcaption>STL images for planning<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/6-1.jpg\" alt=\"\" data-id=\"1358\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1358\" class=\"wp-image-1358\" \/><figcaption>STL images for planning<\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<p>After this time a CBCT was taken of the maxilla\nto start planning the surgery for the placement of two implants in positions 12\nand 22. During the analysis of the x-ray images, as the measurements indicate,\nit was observed that the mesio-distal space between 11-13 and 21-23 was\nlimited, which would impede the placement of two standard implants with a\ndiameter of 3.3 mm. <\/p>\n\n\n\n<p>Given the circumstances and seeking optimum resolution of the case, it was decided to use <strong>Biomimetic Pearl<\/strong> implants with a reduced diameter of 2.8 mm by Avinent Implant System. These mini-implants have a prosthetic line for single restorations and, within their wide range, we found them to be the best choice for the case requirements, as they allow the distribution of space to be perfectly maintained and the biology of the restoration to be respected.<\/p>\n\n\n\n<p>The surgery was carried out for the simultaneous placement of the 2.8 x 13 mm Pearl implants in positions 12 and 22 following the protocol indicated by the company. They were inserted successfully despite the fact that the anatomical conditions were not ideal, with a torque of 30 Ncm achieved in both.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/7-1.jpg\" alt=\"\" class=\"wp-image-1360\" \/><figcaption>Post placement x-ray of the Pearl implants<\/figcaption><\/figure><\/div>\n\n\n\n<p>During the osseointegration period of the implants and up to the start of the prosthetic stage, the patient used the provisional prosthesis she had worn since the completion of the orthodontic treatment. The prosthesis manufactured by the laboratory was a Vacupress splint with two resin teeth to cover the absences of 12 and 22.<strong>Post placement x-ray of the Pearl implants.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-gallery columns-3 is-cropped wp-block-gallery-3 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/8.jpg\" alt=\"\" data-id=\"1361\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1361\" class=\"wp-image-1361\" \/><figcaption>Images of the osseointegration period of the implants and healing of the tissues<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/9.jpg\" alt=\"\" data-id=\"1362\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1362\" class=\"wp-image-1362\" \/><figcaption>Images of the osseointegration period of the implants and healing of the tissues <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/10.jpg\" alt=\"\" data-id=\"1363\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1363\" class=\"wp-image-1363\" \/><figcaption>Images of the osseointegration period of the implants and healing of the tissues <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/11.jpg\" alt=\"\" data-id=\"1364\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1364\" class=\"wp-image-1364\" \/><figcaption>Images of the osseointegration period of the implants and healing of the tissues <\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<p>After three months of osseointegration, the second surgery performed on both implants and the digital impressions were taken with the <strong>TRIOS (3Shape) intraoral scanner<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-gallery columns-3 is-cropped wp-block-gallery-4 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/12.jpg\" alt=\"\" data-id=\"1365\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1365\" class=\"wp-image-1365\" \/><figcaption>Details of the digital impression with the scan abutments placed in the mouth<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/13.jpg\" alt=\"\" data-id=\"1366\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1366\" class=\"wp-image-1366\" \/><figcaption>Details of the digital impression with the scan abutments placed in the mouth <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/14.jpg\" alt=\"\" data-id=\"1367\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1367\" class=\"wp-image-1367\" \/><figcaption>Details of the digital impression with the scan abutments placed in the mouth <\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<p>The impressions were sent to a reliable\nprosthetics laboratory to make provisionals while they worked on the CAD-CAM\ndesign and manufacture of the definitive zirconium crowns.<\/p>\n\n\n\n<p>The milled monolithic zirconium crowns with\ncut-back were cemented on two titanium bases previously cut to correct the\ninsertion axis of the implants.<\/p>\n\n\n\n<ul class=\"wp-block-gallery columns-3 is-cropped wp-block-gallery-5 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/15.jpg\" alt=\"\" data-id=\"1368\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1368\" class=\"wp-image-1368\" \/><figcaption>Details of the laboratory work with titanium bases on a digital model printed in 3D<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/16.jpg\" alt=\"\" data-id=\"1369\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1369\" class=\"wp-image-1369\" \/><figcaption>Details of the laboratory work with titanium bases on a digital model printed in 3D <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/17.jpg\" alt=\"\" data-id=\"1370\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1370\" class=\"wp-image-1370\" \/><figcaption>Details of the laboratory work with titanium bases on a digital model printed in 3D <\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/18.jpg\" alt=\"\" class=\"wp-image-1371\" \/><figcaption>Manufacture of the Zr crowns<\/figcaption><\/figure>\n\n\n\n<p>After a few days, the pertinent x-ray and\nclinical controls were carried out and the two crowns were definitively\ncemented, completing the restoration of the agenesis of the two lateral\nincisors 12 and 22. <\/p>\n\n\n\n<ul class=\"wp-block-gallery columns-3 is-cropped wp-block-gallery-6 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/19.jpg\" alt=\"\" data-id=\"1372\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1372\" class=\"wp-image-1372\" \/><figcaption>Definitive Zr crowns post-load<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" width=\"800\" height=\"500\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/20.jpg\" alt=\"\" data-id=\"1373\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1373\" class=\"wp-image-1373\" srcset=\"https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/20.jpg 800w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/20-300x188.jpg 300w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/20-768x480.jpg 768w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/20-180x113.jpg 180w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/20-360x225.jpg 360w, https:\/\/avinent.com\/wp-content\/uploads\/2021\/05\/20-640x400.jpg 640w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption> <br>Definitive Zr crowns post-load <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/21.jpg\" alt=\"\" data-id=\"1374\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1374\" class=\"wp-image-1374\" \/><figcaption> <br>Definitive Zr crowns post-load <\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/22.jpg\" alt=\"\" data-id=\"1375\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1375\" class=\"wp-image-1375\" \/><figcaption> <br>Definitive Zr crowns post-load <\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-gallery columns-2 is-cropped wp-block-gallery-7 is-layout-flex wp-block-gallery-is-layout-flex\"><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/23.jpg\" alt=\"\" data-id=\"1376\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1376\" class=\"wp-image-1376\" \/><figcaption>X-ray images of the revision at 6 months post-placement of the implants and 2 months after prosthetic load<\/figcaption><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img decoding=\"async\" src=\"https:\/\/blog.avinent.com\/wp-content\/uploads\/sites\/9\/2021\/05\/24.jpg\" alt=\"\" data-id=\"1377\" data-link=\"https:\/\/blog.avinent.com\/?attachment_id=1377\" class=\"wp-image-1377\" \/><figcaption>X-ray images of the revision at 6 months post-placement of the implants and 2 months after prosthetic load <\/figcaption><\/figure><\/li><\/ul>\n\n\n\n<p>The <strong>Biomimetic Pearl<\/strong> system enables minimally invasive treatment of single cases with limited space resulting in a final restoration that meets the patient&#8217;s functional and aesthetic expectations.<\/p>\n\n\n\n<p>Currently the good clinical behaviour of\nmini-implants, with diameters under 3 mm, means they can be used reliably in\nthe long term.<\/p>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\t\t\t\tBiomimetic Pearl system allows treating single cases with limited space in a minimally invasive way, such as the following case by Dr. Javier Alins\t\t\t\t<\/p>\n","protected":false},"author":2,"featured_media":6358,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[35],"tags":[],"profesional_medics":[149,194],"segment":[232,170],"class_list":["post-6013","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-cases","profesional_medics-dr-javier-alins","profesional_medics-dr-javier-alins-en","segments-implants-en","segments-implantes"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u25b7Restoration of 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