德國 Bredent-Medical 2022 植牙學術論文

BioHPP abutment applied for immediate crown restoration during single implant surgery in aesthetic area

▲(Chen T K)

【Abstract】

Based on the characters of bio-compatiblity, force-absorption, whitish appearance, BioHPP abutment is applied in combined level-I/implant-installation & level-II/ BioHPP-abutment-installation surgeries as a one-time-therapy ended up with a provisional crown altogether done in just one surgery/appointment for restoration of a missing tooth in front aesthetic area in this case report. After 9 months, the Zirconium/permanent crown is installed/delivered and there is no further soft/hard tissue-graft or any kind of surgery proceeded beside the above-mentioned. After nearly one more year on the follow-up appointment, the long-gone interdental papillae beside the implant/crown grow back well both mesial & distal proximal, and the black triangles obviously seen on the permanent-crown-delivery-day have no longer existed anymore.

 【 Chief complaint & diagnosis of the patient before treatment】

 28-yr male, suffering from crown broken of #21 and asking for the possibility of implant rehabilitation, no systemic disease, no interdental papillae both proximal. (Fig 01 & Fig 02)

【Treatment plan】

 In one time appointment, doing extraction of the residual root of #21, the level-I surgery by implant installation, the level-II surgery by abutment installation, and provisional crown installation immediate alltogether, with implant 3.5/16 mm narrow Blue-SKY/Bredent and BioHPP abutment 15° in small size Bredent.

【 Procedure and design of the surgery】

Oct-12-2019 

        Level I＋Level II surgeries＋provisional crown

1.  Extraction of #21 (Fig 03 & Fig 04)

2.  To design a pouch beneath facial gingiva and bone of #21 and extend to distal proximal areas of adjacent teeth, #11 & #22 as Fig-05 by utilizing a gingival separator.

3.  The designed path of drilling for the implant is not directly through the apex spot of #21, but done palatally and slightly angularly on the palatal hill with a new drilling orifice quite near the apex spot. (Fig 06)

4.  After being done as what is designed as Fig 06, the scene shows two holes at the socket of #21. The facial hole is the original residual root position, and the palatal hole is a new drilled hole for the implant-3.5/16 mm. (Fig 07-1 & Fig 07-2)

5.   Implant-3.5/16 mm narrow Blue SKY-Bredent is installed iso-crestally to the facial margin of the bone wall by torch on 40 Nt-cm, meanwhile shaping a space in width of approximately 3.5 mm between the implant and the inner surface of the facial bone wall. (Fig 10)

6.  Checking the primary stability to get ISQ/67(above 55) considered OK for immediate restoration.

7.   Choosing BioHPP abutment in 15°/small(Bredent/Germany) instead of 0° (Fig 12) to compensate the angular bias of the drilled path to an harmonic curved 3-D alignment with adjacent teeth(Fig 12, Fig 13, Fig 14-1), and letting BioHPP-abutment be installed on torch by 25 Nt-cm with the implant. (Fig 14-2)

8.  Putting well-cut collagen membrane(rectangle part) inside the designed pouch beneath gingiva as Fig-05., and filling GBR iso-crestally into the gap between facial bone wall and implant-abutment, and covering collagen-membrane(circle part) on and let through the BioHPP-abutment(Fig-15, Fig 16-1, Fig 16-2, Fig 16-3), which are designed as the sketch of Fig 16-4.

9. Installing a provisional crown(PMMA) on BioHPP-abutment immediately after suturing so implant-abutment-crown are all done in one time therapy which takes about 90 minutes altogether in one appointment. (Fig 18)

July-14-2020

         Recalled for preparation of permanent crown after nine months since surgery-day

11.   After nine months from one-time-therapy-day, the patient is recalled with bad oral hygiene but good recovery of gingival and bony outlooks around BioHPP-abutment. (Fig 19)

12.    Doing permanent crown preparation, gingicord application, and impression for the BioHPP-abutment as a natural tooth then getting a Zirconium crown from the lab. (Fig 20-1, Fig 20-2, Fig 21)

July-30-2020 

13.  After 9 months from one-time implant-abutnent surgery day, good gingival and bony forms around BioHPP-abutment are shown just before permanent crown installation on delivery day when oral hygiene of the patient has been asked to be kept well. (Fig 22)

14.    Zirconium crown installation on the BioHPP-abutment of #21 shows no interdental papillae but black triangles both at mesial and distal proximal areas(Fig 23-1). The X-ray shows nothing particular on this delivery day(Fig 23-2).

May-06-2021 

         18 months after-surgery / 9 months after-delivery follow-up

15.   On the day for follow-up after 18 months since implant/BioHPP-abutment-surgery-day which is after 9 months since permanent-Zr-crown-delivery-day, the interdental papillae of #21 have fully grown and filled up the spaces both mesially & distally which shows no black triangles aside anymore even the oral hygiene is not in good condition meanwhile. The facial ridge/gingiva of #21 is also in a plump shape which is the same as the symmetry natural tooth of #11. (Fig 24-1)  It is worthy to be noticed that there has been no further surgery for any soft or hard tissue graft since the one-time-surgery 18 months ago when no titanium frame or pin applied. The plump natural outcome is achieved only by natural growth of the original gingiva and natural osseo-integration on its own(Fig 24-2).

16.   After 18 months from the implant-surgery-day, the X-ray film shows well grown alveolar bone around and good osseo-integration of the implant and it explains why there is a plump natural outlook of the facial ridge/gingiva of #21. And all of these seem not to be affected by the long-term low-grade oral hygiene of the patient(Fig 24-3).

【 Discussion & Conclusion】

1.  One-time-surgery-therapy spares more recession of the bone level surround the implant from the multiple surgeries by open-flap and patient’s more suffers in the clinic. It also provides the immediate prosthetic to keep patient’s social life form being interrupted during waiting for osseo-integration’s being developed(Fig 18).

2.   BioHPP(Biocompatible High Performance Polymer) is made from PEEK(well-known applied in intervertebral discs and hip joint prostheses for 40 years due to being compatible and force- absorbent properties) mixed with 30% ceramics, so as the BioHPP abutment may play a buffer role like the periodontal ligament which absorbs the instant high peak of occlusal force to keep the tooth or implant itself from being damaged by concussion. The one-time-therapy of this report is therefore done by the force-absorbent character of the BioHPP abutment and the objective ISQ-value/primary-stability of the implant.

3.   The pouch, as submerged design as Fig 05 without any further cut on the gingiva of labial ridge, firmly holds the collagen membrane steadily so as to fix the GBR inside positively. Beside the above mentioned, there is no further surgery of any tissue graft until the delivery-day. That is, the lowest invasive move is supposed to achieve or promise the well-growth/outlook of the soft and hard tissues around #21(Fig 16-4).

4.  It’s common for an Asian from Far East to have a thin labial alveolar wall (Fig 07-1) usually seen after front tooth extraction. Moreover, the alveolar crest is also thin so inevitably the path of insertion of the implant has to be designed a little bit palatally angular from the path of extraction, as Fig 06, like the case of #21 in this report to insure the future labial bone is grown thick enough by leaving a space for GBR (Fig 10, Fig 16-1) at least 2 mm in width from labial bone to the implant. The angular bias may be compensated by an BioHPP-abutment in 15° (Fig 12, Fig 14-1) and the compensation may be done more by crown-preparation on the BioHPP-abutment because BioHPP is easy to be ground out by a diamond burr(Fig 20-1).

5.   Even so thin but with natural blood supply and in a good holding form seen after extraction of #21(Fig 07-1), the labial bone wall can do a good job firmly/steadily to hold/cover the GBR inside with a proper coverage of the collagen membrane on top roof to keep the osseo-integration well developed and soft/hard tissue well grown in a situation without interruption(Fig 16-3, Fig 16-4). Therefore any further graft with the aid of being like put-on & taken-out the Titan frame is not necessary(Fig 24-2).

6.   From the recording photos of this treatment, there is seldom plaque accumulated around BioHPP-abutment even under long-term low-grade oral hygiene of the patient(Fig 19, Fig 24-1) so we still can see the original black triangles both mesial & distal proximal of #21 disappears in 9 months by being filled with well-grown interdental papillae. Beside being bio-compatible, it may be also due to the surface roughness of BioHPP which can achieve 0.05μm and it is hard to get plaque accumulation on such fine grained surface.

7.  After consult with Doctor, the patient chose Zr-crown in Vita-A2 shade to restore #21 as a beginning of a long way esthetic treatment for all the other front teeth since they are so disharmonic with each other in color shade(Fig 19) when he can afford it gradually(Fig 23-1).

【References】

1.  Markovic A, Calvo-Guirado JL, Lazic Z, Gomez-Moreno G, Calasan D, Guardia J, et al. Evaluation of Primary Stability of Self-Tapping and Non-Self-Tapping Dental Implants. A 12-Week Clinical Study. Clinical implant dentistry and related research 2011 Dec 15.

2.  Frau Candida Sturz. Effect of different chair-side surface treatment methods on dental restorative materials with respect to contact angles and surface roughness. Uniklinik Koeln-Vorklinische-Zahnheikunde. 20.01.2014.

3.  Sebastian Bauer, Marlis Eichberger, Bogna Stawarczyk, Retentionskraefte von Teilprothesenklammern aus PEEK-basierten kunststoffen. Ludwig-Maximillian Universitaet Muenchen-Poliklinik fuer Zahnaerztliche Prothetic. 08.05.2014.

4.  Priv.-Doz. Dr. Dipl.-Ing. (FH) Martin Rosentritt, Prof. Dr. Carola Kolbeck. Versuch zur Ueberpruefung der AbzugSkraefte zwischen Abutment (Titan, BioHPP) und Kaeppchen (ZrO2 BioHPP) mit 4°/ 8° Konus-winkeln zur Verifizierung verschiedener Zemente. Universitaetsklinikum Regensburg-Poliklinik fuer Zahnaerztliche Prothetik. 01.07.2014.

5.  Professor Lars Sennerby. Resonance Frequency Analysis for Implant Stability Measurements, INTEGRATION DIAGNOSTICS UPDATE 2015;1:1-11.