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Table of Contents
REVIEW ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 46-49

New teeth in one day: Immediate implant replacement of a single tooth using the copy-abutment technique


Academy for Oral Implantology, Vienna, Austria

Date of Web Publication26-Jun-2018

Correspondence Address:
Werner Millesi
Academy for Oral Implantology, Lazarettgasse 19/DG, A-1090 Vienna
Austria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HMJ.HMJ_33_18

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  Abstract 


Losing teeth – particularly in the aesthetic zone of the anterior maxilla – represents a great dilemma for a patient and a challenge for the attending dentist. Immediate placement of dental implants at the day of tooth extraction is an established treatment concept that offers the possibility to provide fixed provisional crowns within few hours. Troublesome removable prostheses can thus be avoided, and the psychological trauma of tooth loss is minimised. The Copy-abutment technique was developed at the Academy for Oral Implantology in Vienna (Austria) and guarantees the best possible preservation of soft-tissue aesthetics by immediate implant restoration using custom-made abutments composed of highly aesthetic zirconia ceramic. On the basis of a modern all-digital workflow and a close cooperation with the affiliated dental laboratory, it is possible to provide the patient with a new tooth in just 1 day.

Keywords: Dental implants, implant aesthetics, single-tooth implant crown


How to cite this article:
Millesi W, Busenlechner D, Fürhauser R, Haas R, Mailath-Pokorny G, Pommer B. New teeth in one day: Immediate implant replacement of a single tooth using the copy-abutment technique. Hamdan Med J 2018;11:46-9

How to cite this URL:
Millesi W, Busenlechner D, Fürhauser R, Haas R, Mailath-Pokorny G, Pommer B. New teeth in one day: Immediate implant replacement of a single tooth using the copy-abutment technique. Hamdan Med J [serial online] 2018 [cited 2018 Jul 22];11:46-9. Available from: http://www.hamdanjournal.org/text.asp?2018/11/2/46/235235




  Introduction Top


Reasons for single-tooth gaps are manifold and involve deep carious lesions, failing endodontic treatment [Figure 1], progressive periodontal disease with subsequent tooth loosening, hypodontia (congenitally missing teeth) and trauma. Injury-related tooth loss, in particular, occurs predominantly in the anterior region of the upper jaw; however, tooth gaps in the aesthetic zone are of exceptionally high relevance for patients [1] compared to missing teeth in the posterior parts of the mouth. Most patients, therefore, strongly wish for a quick prosthetic restoration to be able to go on with their everyday social life. Treatment options to restore single-tooth gaps include removable partial dentures (naturally not favoured due to disturbing coverage of parts of the palate as well as the negative effects of clasps that retain the prosthesis), fixed bridges on the neighbouring teeth (associated with the inherent downside of damage to the natural teeth in the course of bridgework preparation) and the placement of dental implants.[2]
Figure 1: Cross sections showing the large chronic inflammation around the root of the tooth (left) and the well-osseointegrated implant after a healing period of 3 months (right)

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Titanium implants are the preferred choice for single-tooth rehabilitation as they replace the root of the missing tooth, and thus, no additional load is transferred to the remaining dentition.[3] Compared to fixed bridges (that anchor the artificial tooth crown on the neighbouring teeth), single-tooth implants do not cause damage to the adjacent teeth and are particularly recommended when the natural teeth are healthy and have not yet had large fillings or root canal treatment. Removable partial dentures, on the other hand, are increasingly going out of fashion, and young patients, in particular, are aiming to avoid prostheses as long as somehow possible. The major advantages of immediate implant placement at the time of tooth extraction are the reduction of surgical interventions and the possibility of immediate fixed restoration [4] to avoid removable provisionals.


  Indication Span and Preoperative Workup Top


Immediate insertion of dental implants at the time of tooth extraction is a safe and predictable procedure if the tooth socket has not been damaged by major inflammation or severe trauma.[5] In case of acute purulent inflammatory processes or large cysts, a healing period after tooth removal must be respected; however, chronic inflammation does not pose a contraindication to simultaneous extraction and implant placement. General conditions that contradict dental implants involve a history of jaw radiation or chemotherapy, severe osteoporosis, uncontrolled diabetes, as well as on-going periodontal disease and bad oral hygiene. According to the digital workflow developed at the Academy for Oral Implantology, the first optical scan is performed intraorally even before tooth removal [Figure 2]. By this means, the initial soft-tissue situation is captured and the three-dimensional (3D) planning of the implant position [Figure 3] can be performed on pre-operative cone-beam computed tomographic scans. Correct 3D positioning is considered crucial for a successful aesthetic outcome as deviations of only 0.8 mm can significantly compromise the aesthetic result.[6]
Figure 2: Digital workflow: Intraoral optical scanning of the tooth and surrounding soft tissues obviate the need for traditional impressions, three-dimensional planning of custom-made zirconia ceramic abutments that replicate the anatomy of the natural tooth (Copy-abutment technique) and computer-aided design and computer-aided manufacturing of the implant crown

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Figure 3: Initial situation of a left central incisor in the upper jaw of a 45-year-old woman that needs to be replaced due to failing endodontic treatment: Frontal (a) and lateral (b) view

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  Immediate Implant Placement Top


Under local anaesthesia, the failing tooth is extracted very carefully using special equipment to preserve the surrounding bone. In the majority of cases, the bony walls of the tooth socket are kept intact, and the inflammatory tissue can be removed. As the implant is inserted through the opening of the socket, no soft-tissue incision or sutures are required. The implant preparation is performed in an approximately 30° angle to the tooth axis to anchor the implant in the healthy bone towards the palatal or lingual side of the tooth socket. Thus, a primary implant stability of 35 Ncm or more can be reached that facilitates the immediate restoration of the new implant via provisional crowns. Swelling and pain during as well as after immediate implant surgery have proven to be minimal compared to conventional surgical techniques.[7] Painkillers are routinely administered; however, patients report that they need medication for no longer than 2 days or even shorter.[8] Prophylactic antibiotic medication is prescribed as a one-shot therapy at the day of surgery only.


  Immediate Prosthetic Rehabilitation Top


Immediately after implant placement, a second optical scan is performed to record the exact implant position in the mouth, and the digital data are sent to the Dental Laboratory. The fabrication of zirconia ceramic abutments is initiated instantly after computer-aided design using the optical scan of the preoperative soft-tissue situation as a reference. The success of the Copy-abutment technique relies on the exact replication of the 3D anatomy of the natural tooth to be replaced. For this reason, no standardised implant components are used as each patient situation calls for an individualised ceramic abutment that perfectly supports the peri-implant soft tissues and thus guaranteed satisfactory aesthetic results. Owing to the fast digital workflow and the computer-aided manufacturing using ceramic milling machines, the final zirconia abutment can be manufactured within a few hours and is screwed on the implant on the day of surgery already. Thereafter, the Copy-abutment is never removed from the implant body again so that bone loss and soft-tissue recession associated with multiple abutment changes are circumvented. The provisional crown is administered just a few hours after tooth removal so that there is no need for removable provisional dentures during the entire treatment course [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9].
Figure 4: Provisional implant crown manufactured at the day of tooth extraction, well-healed situation at the control visit after 1 week

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Figure 5: Panoramic X-rays before tooth extraction (above) as well as after immediate implant placement (below)

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Figure 6: All-ceramic final implant crown manufactured 3 months after implant placement

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Figure 7: Custom-made zirconia Copy-abutment screwed on the implant

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Figure 8: Final implant restoration cemented on the Copy-abutment

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Figure 9: Intraoral X-ray of dental implant and final implant crown in place

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  Results Top


The Academy for Oral Implantology was founded in 2004 in Vienna, Austria, and has treated over 15,000 patients ever since.[9] Patient records were kept of each of the 25,000 dental implants placed. Following the immediate implant concept and Copy-abutment technique, we record 10-year implant success rates of 97%, minimal peri-implant bone remodelling of <1 mm and imperceptible soft-tissue recession of 0.5 mm, on average.[10] These results are documented by over 100 scientific publication in international peer-review journals by our team.


  Conclusion Top


After a healing period of at least 3 months, the final all-ceramic crown is attached to the implant [Figure 8]. Compared to other therapeutic approaches, the immediate implant concept carries the big advantage of significantly shortening the treatment duration; however, the major benefit is the preservation of peri-implant soft tissues due to the optimised support from the 1st day after tooth extraction on. The Copy-abutment technique thus obviated the need for invasive soft-tissue augmentation procedures and renders a perfect aesthetic outcome with just one surgical intervention possible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pommer B, Mailath-Pokorny G, Haas R, Busenlechner D, Fürhauser R, Watzek G, et al. Patients' preferences towards minimally invasive treatment alternatives for implant rehabilitation of edentulous jaws. Eur J Oral Implantol 2014;7 Suppl 2:S91-109.  Back to cited text no. 1
    
2.
Mailath-Pokorny G, Fürhauser R, Pommer B. New anterior teeth – The same day: The immediate-placement concept of the Academy of Oral Implantology in Vienna. Eur J Dent Implantol 2015;11:46-9.  Back to cited text no. 2
    
3.
Pommer B, Krainhöfner M, Watzek G, Tepper G, Dintsios CM. Relevance of variations in the opposing dentition for the functionality of fixed and removable partial dentures: A systematic review. Int J Dent 2012;2012:876023.  Back to cited text no. 3
    
4.
Busenlechner D, Mailath-Pokorny G, Haas R, Fürhauser R, Eder C, Pommer B, et al. Graftless full-arch implant rehabilitation with interantral implants and immediate or delayed loading-part II: Transition from the failing maxillary dentition. Int J Oral Maxillofac Implants 2016;31:1150-5.  Back to cited text no. 4
    
5.
Monje A, Pommer B. The concept of platform switching to preserve peri-implant bone level: Assessment of methodologic quality of systematic reviews. Int J Oral Maxillofac Implants 2015;30:1084-92.  Back to cited text no. 5
    
6.
Fürhauser R, Mailath-Pokorny G, Haas R, Busenlechner D, Watzek G, Pommer B, et al. Esthetics of flapless single-tooth implants in the anterior maxilla using guided surgery: Association of three-dimensional accuracy and pink esthetic score. Clin Implant Dent Relat Res 2015;17 Suppl 2:e427-33.  Back to cited text no. 6
    
7.
Pommer B, Busenlechner D, Fürhauser R, Watzek G, Mailath-Pokorny G, Haas R, et al. Trends in techniques to avoid bone augmentation surgery: Application of short implants, narrow-diameter implants and guided surgery. J Craniomaxillofac Surg 2016;44:1630-4.  Back to cited text no. 7
    
8.
Fürhauser R, Mailath-Pokorny G, Haas R, Busenlechner D, Watzek G, Pommer B. Patient-perceived morbidity and subjective functional impairment following immediate transition from a failing dentition to All-on-4® fixed implant rehabilitation. Int J Oral Maxillofac Implants 2016;31:651-6.  Back to cited text no. 8
    
9.
Busenlechner D, Fürhauser R, Haas R, Watzek G, Mailath G, Pommer B, et al. Long-term implant success at the Academy for Oral Implantology: 8-year follow-up and risk factor analysis. J Periodontal Implant Sci 2014;44:102-8.  Back to cited text no. 9
    
10.
Fürhauser R, Mailath-Pokorny G, Haas R, Busenlechner D, Watzek G, Pommer B, et al. Immediate restoration of immediate implants in the esthetic zone of the maxilla via the copy-abutment technique: 5-year follow-up of pink esthetic scores. Clin Implant Dent Relat Res 2017;19:28-37.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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Abstract
Introduction
Indication Span ...
Immediate Implan...
Immediate Prosth...
Results
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