Accelerated Healing, Rapid Recovery Using Trabecular Metal Implant

Suheil M. Boutros, DDS, MS

A healthy 57-year-old male patient presented interested in having his missing maxillary right first molar replaced with an implant-supported restoration in an accelerated treatment protocol. A periapical radiograph and a cone-beam computed tomography (CBCT) scan revealed that the residual height of bone from the crest to the sinus floor was 6 mm. A Trabecular Metal^™ Implant (Zimmer Biomet, zimmerbiometdental.com) was chosen for this case, because it is well-suited for use in rapid recovery cases, as the implant is capable of accelerating healing and bone formation through the multiplication of naturally occurring growth factors related to bone formation, wound healing, and vascularization. A full-thickness flap was reflected using a crestal sinus approach, and the sinus lift/implant osteotomy was prepared. The implant and a BellaTek^® Encode^® Healing Abutment (Zimmer Biomet) were placed in a single-stage protocol. A definitive BellaTek (CAD/CAM) Abutment and an IPS e.max^® crown (Ivoclar Vivadent, ivoclarvivadent.com) were placed at 5 weeks post-sinus lift and implant placement.

Timely case completion-Placing the Trabecular Metal Implant, whether in a late placement or immediate placement, offers the advantage of completing cases in a predictable, faster approach versus conventional implant therapy. A provisional restoration may be placed at the time of implant placement, followed by placement of a definitive restoration as early as 4 to 6 weeks.

Esthetically demanding cases-In esthetically demanding cases such as the one presented, the clinician had to allow for soft-tissue healing compared to placement in a healed ridge.

Bone ingrowth and secondary stability-The bone ingrowth and secondary stability facilitated by the Trabecular Metal Implant enables completion of cases more quickly, especially in multi-unit cases.

Suheil M. Boutros, DDS, MS
Private Practice, Grand Blanc
Clarkston, and Dearborn Heights, Michigan
Visiting Assistant Professor
Department of Periodontics
University of Michigan
School of Dentistry
Ann Arbor, Michigan

Figures and Images

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Figure 1

Fig 1. Preoperative periapical radiograph showed the missing maxillary right first molar

Figure 2

Fig 2. A crestal sinus lift was performed using a crestal sinus approach (CSA) bur and stopper.

Figure 3

Fig 3. Following the sinus lift, no perforation or tearing of the Schneiderian membrane was noted. Puros® Cortico-Cancellous Particulate Allograft (Zimmer Biomet) was placed into the osteotomy.

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Fig 4. A 6-mm diameter x 10-mm length Trabecular Metal Implant was placed, with a primary stability of 30 Ncm.

Figure 5

Fig 5. Final implant position. A healing abutment will be placed in lieu of a cover screw.

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Fig 6. A BellaTek Encode Healing Abutment was placed into the implant, and the soft tissues were closed with interrupted chromic gut sutures.

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Fig 7. Periapical radiograph demonstrated the radiopaque appearance of the fully seated healing abutment and the graft material apical to the implant.

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Fig 8. Soft-tissue healing around the BellaTek Encode Healing Abutment was at an acceptable biological level at 4 weeks postoperative.

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Fig 9. The digital design of the definitive BellaTek Abutment was sent to the referring dentist for approval, then converted to a screw-retained restoration using 3Shape® CAD/CAM (3Shape, 3shape.com).

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Fig 10. Delivery of a BellaTek Abutment/e.max screw-retained restoration at 5 weeks post-implant placement. The screw was appropriately torqued to recommended levels.

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Fig 11. Full occluding restoration on day of delivery, 5 weeks post-implant placement.

Figure 12

Fig 12. Radiographic verification at the final occlusal check appointment at 8 weeks post-restoration.