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Author details

Anastase George
Freelancer in Costanza (Romania)

Rehabilitation with monophasic implants in three post-extraction sites with immediate load


Anastase George


In this clinical case, we wanted to show the extreme simplicity and advantages of using one-stage implants, exploiting their unique peculiarities: minimally invasive and excellent primary stability, which make them particularly suitable for immediate loading even in areas of particular atrophy.

The use of monophasic implants is increasingly indicated nowadays, given their simplicity of use and effectiveness. The surgical protocols refer to the classical principles of the great Italian school of implantology and the successes obtained and documented by the great pioneers and numerous Italian and non-Italian authors. They gave rise to the philosophy and reality of immediate loading.
The goal is to obtain maximum implant stabilization even in post-extraction sites deferred by six/eight weeks from the extractions. The possible search for particular structures, such as cortices, provides the maximum primary stability.

We achieved this result by preparing a minimally invasive site simply using a single lance drill with a maximum diameter of 2 mm, a peculiarity of NSI basal and compression implants. This strategy allows better anchoring and better primary stability for the eventual bending and orientation of the abutment.
Thanks to NSI’s Maxifix Compressive implants is possible to obtain the best prosthetic insertion axis. Furthermore, the monophasic NSI can be widely tilted up to 40 ° with ease, without risk of breakage, with a certified guarantee of success in the short and long term (mechanical tests carried out in 2019 by the Politecnico di Milano).

The literature from the 1960s to today has consistently demonstrated and amply documented with proven scientific evidence that the insertion of “monobloc” implants in immediate, deferred post-extraction sites guarantees success rates between 90 and 100%.
The particular disposable prosthetic kit included in the blister of the NSI implant, the impression phase, and the development of the model by the technician is mainly facilitated both with the traditional and digital methods.


The case treated concerns a 64-year-old female patient with various problems spread in the arches who came to our observation to solve an essential issue of functional aesthetic deficit concerning the frontal part.

At the clinical examination, extractions 11-12-21 had to be performed, compromised elements with significant mobility.
X-ray examination reveals apical resentments and poor bone quality, but good vertical bone availability with poor consistency and thickness is appreciated.

Fig. 1

Fig. 2a

Fig. 2b

It was decided together with the patient to carry out a post-extraction deferred implant treatment in the first phase of the elements mentioned above and then continue in the future with the rest of the work.

Once the operating field was clean, a minimally invasive site was created in the frontal group due to the poor bone quality using a single 2 mm diameter lance drill. The goal was to probe the bone quality by looking for those 12/15 mm necessary and the relative cortex to guarantee excellent primary stability.

Given the poor bone quality, we preferred to orient the 2 mm diameter drill entrance in a slightly inclined vestibule-medial way to insert implants with a diameter of 3.2x15mm on 11 and 21 and diameter 3.7x12mm on 12. This ratio drill/implant was necessary due to the low density of the upper bone, about D4.

Taking advantage of the Maxifix Compressive NSI implants’ particular self-threading, it was possible to obtain remarkable primary stability, around 50/60 Ncm.

Fig. 3

Fig. 4

The implant is a monobloc with a cutting and progressive coil, a large pitch, a conical body, a sandblasted and etched surface.

In the same session, we have taken an impression with the particular NSI disposable prosthetic kit, which allowed, thanks to the technician’s availability, to apply the definitive in the day immediately.

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