NDI Medical
By Dr. Miriam Mujakovic and Dr. Michael Claar
Multiple implantations at reduced bone supply with a special implant design

The dental implantology is indispensable in the dental practice since its introduction by Professor Brånemark in the 60s of the last century. It has decisive changed and developed dental medicine. Since the beginning, people are suffering from the trauma of tooth loss and in many cases they were treated insufficient and unsatisfactory with the, at the time offered prosthetic concepts.

Through the introduction of the intraosseous implant, this has been significantly improved.

So we can nowadays realize in many cases, the desire in patients with extremely compromised bone situations, for fixed dental prostheses using modern Augmentative measures and techniques and special implants. The further development in the field of augmentation materials has narrowed in the last few years the indication for an autologous bone transfer (keyword: Intra and extra oral removal points Also the changes and improvements in the macro and micro area of the implants ensure that even in difficult initial situations a very high clinical success rate can be realized...

The implant system we use in this clinical case "Leader" of the company NIKO Dental shows a very high primary stability in extremely structurally weak bones. This is due to its unique, root-shaped widening implant body. In the area of the implant shoulder, a threaded split exists to serve also the highest aesthetic demands of the patient and therapist. The implant surface is extensive scientifically studied and can be described as absolutely clean and pure.



Clinical case:
A 67-year-old female patient presented herself within the implant consultation with the desire for a fixed prosthetic restoration in the upper jaw. She was instantly supplied with a removable denture, which however caused her great difficulties while eating and speaking (Fig. 1 + 2). The patient was informed in detail about the possibilities of a removable and fixed restoration. Besides the clinical analysis, a preoperative three-dimensional diagnostics (digital volume tomography) was also made (Fig. 2a + 2b).

It showed a significantly reduced bone volume in the area of the right maxillary sinus. In particular, a perforation with complete bony destruction in region 16, 17 could be diagnosed. In the further anterior region of the maxilla, there was a vertical and lateral atrophy.

The patient expressed her explicit desire for a fixed restoration so that the following treatment plan was created:

Implantation in region 15, 16 with simultaneous external sinus lift with inlay of the bone regeneration material and implantation in region 14, 12 and 22 (Fig. 3). Due to the compromised bone site, we opted for the insertion of the "Leader" implant system. Especially in these difficult cases, the special implant design convinces by achieving a high primary stability.

In local anesthesia, the four "Leader" implants were as planned inserted. The illustrations show the simultaneous augmentation and implant placement in the area of the right maxillary sinus. As one can recognize easily, a much reduced residual bone height shows up. Nevertheless, a sufficient primary stability can be achieved (Fig. 4-10).

Also, the other three implants could be easily inserted with good primary stability (Fig. 11).

Furthermore, it is surgically in such difficult cases advantageous that the implant axis can be conditionally modified intraoperatively by the unique processing and Insertions Protocol (Fig. 12-15).

In this clinical patient case, the immediate loading of implants was dispensed and the osseointegration time of four months was selected.

Captions:

Fig. 1: The initial clinical situation in the upper jaw.
Fig. 2: View of the partially edentulous upper jaw without the telescoping dentures.
Fig. 2a: Preoperative three-dimensional X-ray image with stratification in region 16.
Fig. 2b: Representation of the anterior bone availability in the three-dimensional X-ray image
Fig. 3: Preparation of the vestibular antral wall using diamond for external sinus lift.
Fig. 4: Determining the implant position and axis by means of a pilot drill.
Fig. 5: Gradual preparation of the implant cavities.
Fig. 6: Verification of implant axes with parallelizing pins.
Fig. 7: With Tissue Support activated bone regeneration material for incorporation into the maxillary sinus.
Fig. 8: Insertion of the implant Leader.
Fig. 9: Carrying in the procedure of the implant.
Fig. 10: Cover of the brought in augmentation material with Flex Barrier.
Fig. 11: Representation of the jawbone in the anterior maxilla region.
Fig. 12: Implant drills Set of Leader implant.
Fig. 13: Gradual insertion of the dental implant in the anterior maxilla region.
Fig. 14: Postoperative DVT.
Fig. 15: Postoperative radiograph layer representation of the maxillary sinus after augmentation.