NobelActive clinical case: immediate implant placement - Eric Rompen

Nobel Biocare
14 Jan 201612:23
EducationalLearning
32 Likes 10 Comments

TLDRThe transcript describes a meticulous dental procedure involving the placement of an implant. The process begins with the careful examination of the socket area, followed by the drilling procedure to create a hole in the palatal wall. A surgical guide is used to ensure correct orientation and depth. A 13mm implant is then gently placed and checked for proper positioning. The implant's torque is closely monitored to avoid excessive pressure. Subsequently, a bone mill is used to remove excess bone, making way for an aesthetic zirconia abutment. The abutment is tried in, and the crown is adjusted and cemented with precision. The final step involves tightening the abutment and ensuring the crown is well-fitted, with any excess cement removed.

Takeaways
  • 🦷 The procedure involves working with a canine that requires gentle extraction.
  • 🔩 The socket's quality is assessed, noting the presence of soft tissue on the bottle.
  • 🛠️ The drilling process begins with the palatal wall, emphasizing slow and careful correction of the drill's orientation.
  • 📏 The surgical guide is used to check the direction and ensure proper positioning of the drill.
  • 💎 A 13 millimeter long implant is chosen, and care is taken to not apply too much torque.
  • 🔄 The implant is inserted into the palatal wall and then adjusted to go deeper, with the direction checked against the surgical guide.
  • 🔍 The torque is monitored, aiming not to exceed 40-45 newton centimeters for the implant's safety.
  • 🦷 The bone mill is used to remove excess bone on the palatal, ensuring a clear path for the aesthetic abutment.
  • 💍 The zirconia abutment is tried in, and adjustments are made to ensure a proper fit.
  • 👨‍⚕️ The final steps involve placing the abutment back into the mouth and tightening it with a prosthetic torque wrench to 35 newton centimeters.
  • 🌐 The crown is cemented with a limited amount of cementation material, ensuring a precise fit with minimal excess.
Q & A

  • What is the initial procedure being described in the script?

    -The initial procedure described in the script involves the gentle extraction of a canine tooth and the assessment of the socket area, noting the presence of soft tissue on the bottle.

  • What is the significance of the surgical guide in this context?

    -The surgical guide is significant as it helps in determining the ideal position for the collar of the tools and serves as a reference point for the placement of the implant, ensuring proper alignment and direction.

  • How does the dentist plan to handle the dense bone during the drilling procedure?

    -The dentist plans to handle the dense bone by using a 2.8 3.2 drill and proceeding with caution, avoiding putting too much torque on the implants to prevent compressing the bone.

  • What is the implant length mentioned in the script?

    -The implant length mentioned in the script is 13 millimeters.

  • How does the dentist ensure the correct orientation of the implant?

    -The dentist ensures the correct orientation of the implant by checking the direction with the surgical guide and adjusting the position as needed to align with the desired angle.

  • What is the maximum torque the dentist prefers not to exceed?

    -The dentist prefers not to exceed a torque of about 40 to 45 newton centimeters.

  • What is the purpose of using the bone mill in this procedure?

    -The purpose of using the bone mill is to remove excessive bone from the palatal area that could impair the placement of the aesthetic abutment, ensuring a smooth and proper fit.

  • What type of abutment is being used in this procedure?

    -An aesthetic zirconia abutment is being used in this procedure.

  • How is the provisional crown adjusted and placed?

    -The provisional crown is adjusted using a diamond kit for Procera zirconia abutments, shaped to fit correctly, and then placed using a thick resin to secure it onto the implant.

  • How is the final abutment placed and secured?

    -The final abutment is placed by engaging it into the implant and tightening it using a prosthetic torque wrench up to 35 newton centimeters, ensuring a secure fit.

  • What is the final step in the procedure described in the script?

    -The final step in the procedure is cementing the crown, using a limited amount of cementation material, and ensuring that the crown is properly seated with no excess material.

Outlines
00:00
🦷 Dental Implant Procedure

The paragraph describes a live dental implant procedure involving a slightly mobile canine. The speaker is preparing to extract the tooth and begins the process by examining the socket and the surrounding soft tissue. They proceed to the drilling process, carefully entering the palatal wall and adjusting the drill's orientation. The use of a surgical guide is emphasized to ensure correct positioning, and the speaker mentions their preference for a more coronal reference point for implant placement. They also discuss the importance of not compressing the bone and using a 13 mm long implant. The paragraph concludes with the implant being placed and the orientation being checked against the surgical guide.

05:01
📏 Measuring and Adjusting Implant

This paragraph focuses on the precision required during the implant process. The speaker uses an implant driver to measure the distance between the implant top and a reference line, aiming to rebuild the gingiva to this point. They emphasize the importance of not exceeding a torque of 40 to 45 newton centimeters to avoid damaging the implant. The speaker then moves on to use a bone mill to remove excess bone that could interfere with the placement of an aesthetic abutment. They successfully place a zirconia abutment and adjust its shape before settling a provisional crown onto it. The process includes filling the screw hole with resin and ensuring a proper fit.

10:02
💎 Finalizing the Dental Restoration

The final paragraph details the process of finishing the dental restoration. The speaker adapts the resin at the limits to avoid excess material, places the abutment back into the mouth, and ensures proper engagement with a prosthetic torque wrench, tightening it to 35 newton centimeters. The crown is then cemented with a limited amount of cementation material, and the speaker takes care to remove any excess material. The paragraph concludes with the successful placement of the crown, highlighting the importance of meticulous attention to detail in dental procedures.

Mindmap
Keywords
💡Canine
In the context of the video, 'canine' refers to a type of tooth in both humans and animals, specifically the tooth that is typically just behind the incisors and is known for its sharpness, suitable for tearing food. The video mentions a 'canine' which is slightly mobile, indicating that it might be loose or not firmly in place, which is a common issue in dental procedures.
💡Socket
A 'socket' in dental terms refers to the cavity in the jawbone that contains the root of a tooth. In the video, the quality of the socket is being checked before the drilling procedure begins, which is crucial for the successful placement of a dental implant. The socket's condition can significantly affect the stability and integration of the implant with the jawbone.
💡Drilling Procedure
The 'drilling procedure' is a critical step in various dental surgeries, including the placement of dental implants. It involves creating a hole in the jawbone to accommodate the implant. The process must be done with precision to ensure the correct depth and angle, which are essential for the implant's stability and function.
💡Surgical Guide
A 'surgical guide' is a tool used in dental implant surgeries to direct and control the positioning of the drill and the implant. It is designed based on a treatment plan and helps ensure that the implant is placed in the ideal location and at the correct angle, leading to better aesthetics and functionality of the final restoration.
💡Implant
An 'implant' in dentistry refers to a artificial tooth root that is placed into the jawbone to replace a missing tooth. Implants are typically made of biocompatible materials like titanium and serve as a foundation for a dental crown or bridge. The video describes the process of placing an implant, which involves careful preparation of the bone and precise positioning of the implant to ensure successful integration with the jawbone.
💡Torque
In the context of dental implant placement, 'torque' refers to the rotational force applied when inserting the implant into the jawbone or when tightening the components of a restoration, such as a crown. Excessive torque can lead to damage to the implant or the bone, so it is essential to control the amount of force used during these procedures.
💡Zirconia Abutment
A 'zirconia abutment' is a dental component made from zirconium dioxide, a strong and aesthetically pleasing material that is used in the support structure for dental crowns or bridges. Zirconia is valued for its durability, strength, and its ability to mimic the appearance of natural teeth, making it an ideal choice for patients seeking a lifelike and long-lasting restoration.
💡Aesthetic Abutment
An 'aesthetic abutment' refers to a dental component designed with a focus on the visual appeal of the final restoration. It is crafted to blend seamlessly with the surrounding natural teeth, ensuring that the dental work is as unnoticeable as possible. The aesthetic abutment is an essential part of creating a pleasing and harmonious smile.
💡Cementation Material
Cementation material is a substance used to secure dental restorations, such as crowns or bridges, onto dental implants, teeth, or abutments. It plays a critical role in ensuring the stability and longevity of the restoration by providing a strong bond between the dental components. The material must be carefully managed to avoid excess, which can lead to complications.
💡Resin
In dentistry, 'resin' is a type of material used for various restorative procedures, including filling cavities or bonding components together. It is known for its versatility and ability to be molded into different shapes, making it a valuable tool in creating custom dental restorations. Resin can be used to fill gaps, cover the implant, or adjust the shape of the restoration to ensure a perfect fit.
💡Torque Wrench
A 'torque wrench' is a tool used to apply a specific amount of force to a component, such as tightening a screw or fastener, without exceeding a desired limit. In dentistry, a torque wrench is used to ensure that screws or other components are tightened with the correct amount of force to avoid damage to the implant or surrounding tissue.
Highlights

The canine is slightly mobile and ready for gentle extraction.

Soft tissue is present on the bottle, which could affect the socket quality.

The drilling procedure begins with entering the palatal wall and slowly correcting the drill's orientation.

The surgical guide is used to check the direction and ensure it aligns with the ideal position of the implant collar.

The 2.4 2.8 drill is used, with attention to not compressing the bone too much.

A 13 millimeter long implant is chosen for placement.

The implant is placed with careful attention to direction and torque, avoiding excessive pressure.

The distance between the implant top and the line on the implant driver is three millimeters, indicating the desired gingiva rebuild.

The bone mill is used to remove excess bone on the palatal that could hinder the placement of the aesthetic abutment.

The zirconia abutment is tried in and adjusted for a proper fit.

The diamond kit for procera zirconia abutments is used to shape the crown.

The provisional crown is settled correctly onto the implant.

The screw hole is filled with resin to ensure a secure fit.

The abutment is placed back into the mouth with precision, engaging the hack circularly.

The prosthetic torque wrench is used to tighten the abutment screw to 35 newton centimeters.

The crown is cemented with a limited amount of cementation material, ensuring proper seating and minimal excess.

The final result shows the crown well-placed with excess cementation material extruding from the vent hole on the palatal aspect.

Transcripts

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DentalImplantSurgicalGuideBoneMillZirconiaAbutmentProvisionalCrownDentistryMedicalProcedureImplantPlacementTorqueControlAestheticDentistry