Clinica case report

Immediate loading with Maxifix Compressive monophasic soft tissue management

Author: Dr. Kocher Karem, Dentist Surgeon

The case

The patient is 35 years old, has a root residue that is not particularly compromised, in the absence of infections.

The treatment plan

The treatment plan provides for the extraction of the root residue and the insertion of an immediate load implant, with the essential achievement of the second cortex of the upper jaw.

Materials

Monophasic implant NSI Maxifix Compressive, membrane reabsorb, synthetic bone granules
and sterile NSI coping included in the implant blister and photo-polymerizing composite.

Target

Restore the missing element, through the technical use of the immediate load, seeking the primary stability necessary by looking for bone expansion and a reference cortex for the safe stabilization of the implanted element. Particular attention and consideration require the possible post-avulsion complications of the residual root element, in particular the one that concerns the fragility of the extraction site.

Conclusions

This case demonstrates how a single post-extraction edentulous site despite the “open extraction” maneuver of the alveolar structure, thanks to the peculiarities of the NSI implant-prosthetic system concentrated in the characteristics of the Maxifix Compressive monophasic implant, it is possible to proceed and obtain a good result, functional and aesthetic, apply an immediate load even in “compromised” cases.
All this in a single session, ensuring with ease the aesthetic management of soft tissues and the application of the definitive prosthesis.
This was achieved by using simple components that accompany all NSI monophasic implants such as the sterile disposable prosthetic kit, which allowed perfect tissue healing.
In this way it was possible to carry out a definitive functional aesthetic restoration of the missing element only 15 days after the intervention, thus optimizing the time and the final result.

Impianto monofasico gestione estetico funzionale

Clinical details

After careful case analysis and correct preoperative planning, a well-defined surgical protocol must be applied in which nothing is left to chance.
It is important to underline how the extraction of a tooth or as in this case a root residue, does not represent a surgical act in itself: for this reason, the conservation of the alveolus must be obtained by minimizing surgical trauma as much as possible.
This turns out to be fundamental since it allows the best preservation of the volume and the proper bone morphology to obtain better conditions for a future functional aesthetic load of the post-extraction site in function of a subsequent rehabilitation supported by mono-block mono-phase implants.

For the extraction, we, therefore, chose to proceed with a surgical extraction technique
“Open” which involved setting up a flap and ostectomy maneuvers.
This technique, necessary in this case, despite the inevitable invasiveness required, has not compromised the insertion of the immediately loaded implant.
How?

The removal of the vestibular part of the extraction site entailed the need to insert osteoinductive material and a resorbable membrane at the end of that material and prevent the invasion of fibrous tissues into the exposed area, in order to protect the implant body.

Thanks to the peculiarity and profile of the particularly self-tapping coils with large bone expansion capacities, the Maxifix compressive NSI implant, ø5 x 15mm, has been inserted with the aim of obtaining maximum stability by engaging the second bone cortex of the maxilla.
This is to obtain excellent primary stability and “support” that guarantees the long-term success of immediate loading.
In this case, thanks to the opening of the flap and the particular attention and calculation for the positioning of the Maxifix compressive, it was not necessary to bend the abutment, but from the iconography, it is possible to notice the full filling of the post-extraction site with considerable primary stability obtained thanks to the progressive taper of the NSI single-piece implant.

The second very important part of the case concerns the management of soft tissues; which consists in calculating the correct level of how to position the stump which subsequently allows the application of an aesthetically and functionally proportioned crown, using the entire length of the monobloc implant possible in order to stabilize the implant.

NSI offers many sizes from 6mm to 19mm, calculating that the 10mm transgingival central neck has a total length of 3mm to allow the doctor to manage soft tissue.

The NSI Maxifix Compressive monophasic implant is in fact characterized by a neck with a ø 2mm thinner than the shape of the body of the device available in ø3-3-3.7-4.1 and 5. Thanks to this variation of diameters and lengths in place extraction, it is possible to obtain particular and simple management of what the regenerative processes of the gingival tissues are, avoiding peri-implantitis.

This functionality has been particularly exploited and amplified in this specific case thanks to the use of one of the components of the sterile prosthetic kit supplied with the NSI monophasic implant.

The prosthetic kit is composed of a similar transfer and coping for immediate loading.

In this case, the coping was used to immediately build a healing provisional in order to directly condition the gingiva. At the same time as the “disposable transfer”, the impression was taken to proceed with the final work.

Result: at the same time that the soft tissues were healing for 12 days, the definitive element was created by the laboratory, thus allowing the application of the definitive dental element only 2 weeks after the intervention, on completely cured tissues.

Once the patient entered ℅ the dental office was then subjected to NSI Maxifix Compressive immediate load implantology. Despite the problems due to a “complex” extraction, he was still able to take advantage of the opportunity to take advantage of the immediate load implant-prosthetic method. This allowed her to solve a problem that had persisted for years in one session and to go home with a complete smile.

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