Benefits of the Axiom X3® Tissue Level implant in bruxist/smoker patient

Dr. Levs GAVRILOVS

Dental Surgeon

Spilsby, United Kingdom

Post Graduate Certificate:
  • In Implant Dentistry
  • From the British Academy of Implant & Restorative Dentistry (Leeds)
  • In Advanced Implant Dentistry Vita-Salute San Raffaele University (Milan)
  • In Advanced Aesthetic Dentistry UCL Eastman (London)

Introduction

This lovely and healthy gentleman in his 40’s consulted to replace missing LR6, that was extracted 3 months ago due to the abscess. His main goal was to restore the function, aesthetic expectations were low. Intra orally he presented with the missing LR6, sufficient vertical and horizontal space to replace the missing tooth, but clear signs of the present parafunction. Oral hygiene was satisfactory. Patient was a smoker (5-10 per day). All the options to replace the missing tooth have been discussed: accepting the gap, a denture, a bridge or a dental implant. All the risks and benefits of each option were presented, but the patient was only interested in the implant.

Initial situation

1a. 1b. Preoperative occlusal view.

2. My usual protocol is to have a CBCT and intraoral scan for each implant patient, as most of my implant placement is fully guided (using Anthogyr INTEGRAL Guided Surgery kit). Both were carried out at the practice.

3a. 3b. 3c. 3d. SMOP software was used for the planning (reverse/prosthetically driven planning principle). Virtual wax up was created and both DICOM and STL files were merged for the optimal future implant placement (Anthogyr Axiom X3® TL 4.0x10 R2.5). As I was familiar with the Anthogyr Axiom X3® implants (actually the main implant that I use at my practice), I was happy to try the Anthogyr Axiom X3® Tissue Level implant in this case. As it was a molar case, I have decided to use the regular platform (4.8 mm) to get a good emergence profile of the future restoration. Even with digital planning I follow all the basic biological rules. And one of the main ones is the biological width, so in this case I have submerged my implant by 3 mm and have chosen the height of the polished collar as 2.5mm.

4. The treatment plan was accepted by the patient, and I printed the guide (using a 5 mm sleeve, as the width of my polished collar was 4.8mm).

5a. 5b. Guide 3D printed on the printed model.

6. Anthogyr INTEGRAL Guided Surgery kit - Ø5.0 sleeve.

7. Implant to be used.

8. Guide tried in patient’s mouth

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Surgery

9a. 9b. 9c. In this case, due to the sufficient amount of bone I was able to use the flapless approach with the tissue punch.

10. Then, I have followed the Anthogyr Axiom X3® drilling protocol for the type 2 bone (underprepared by 1 drill). The implant was placed through the guide. Torque achieved 50 N.cm. The whole procedure took us about 20 minutes!

11. Cover screw to be placed hand tight.

12. Following the 12 weeks healing period (which was uneventful), the patient came for the final impressions. X-ray was taken and there was minimal bone remodelling.

Prosthetic restoration

13. Master model.

14a. 14b. 14c. Intraoral scan was taken (using TL scan body). The scan was sent to Simeda® milling centre and the final restoration (CAD/CAM abutment and full zirconia crown) was delivered.

Final situation

15a. 15b. Final restoration fitted in the patient's mouth in 2 weeks. Patient and myself were happy with the result.

16. Control X-ray of final restoration.

Conclusion

As an Axiom X3® user I was happy to know that now I have got the option of using a Tissue Level implant, without the loss of Axiom X3® benefits.
What I really liked about the Axiom X3® Tissue Level was:

  • choice of the width of the polished collar (4.0 N and 4.8 R), which allows me to create a nice emergence profile of the restoration.

  • choice of the length of the polished collar, which allows to respect the biological width and place my implant at different depths.

  • possibility to use the fully guided Anthogyr Integral kit (no need to buy extra kits)

  • same reliable quality of the Axiom X3® implant

Tissue Level implants are a well-known option for the compromised patients (perio, smokers, bruxers etc.) So, I am definitely happy to have the Axiom X3® Tissue Level in my armamentarium.