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Immediate full function: One-visit implant placement, final crown in full function. |
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 Following are step-by-step instructions for the single-appointment procedure to place the Sargon Immediate Load Implant in an extraction socket, in full function with a permanent crown.
Internal-connection wide-platform self-tapping implant.
Features
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Proprietary apical expansion feature allows full-function immediate loading at the time of placement, while osseointegration occurs
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Root form design
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Optimal for use in fresh extraction sockets
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Eliminates the need for a provisional while definitive crown is fabricated
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Has a 98% success rate with immediate full-function loading
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While not mandatory, the CO2 laser greatly simplifies socket decontamination
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Estenia hybrid restorative handles like a composite to allow crown shell finishing in the dental office. Its high porcelain content imparts excellent esthetics
Planning
The patient presented with a periapical abscess in tooth No. 9. It was visible as a buccal swelling above the tooth (Fig. 1) and evident in the pre-operative radiograph, which shows previous endodontic treatment (Fig. 2). It was decided to extract the tooth and replace it with an implant. At this consultation appointment, take a preoperative impression for a diagnostic model and determine shade of tooth No. 9. The lab can then fabricate the crown shell. Re-appoint the patient for the one-visit extraction/ implant placement/final crown seating.
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| Fig. 1 A periapical abscess on tooth No. 9 is noted visually, by buccal swelling above the tooth… |
Fig. 2 …and radiographically. |
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| Fig. 3 The socket is debrided using an ultrasonic scaler. |
Fig. 4 The socket is decontaminated with a CO2 laser. |
Treatment
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Extract the tooth.
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Debride the socket with an ultrasonic scaler (Fig. 3).
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Decontaminate the socket using a CO2 laser (DEKA UltraSpeed, www.dekalasers.com) (Fig. 4). Note: Conventional chemical decontamination techniques can be used as well.
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Use a 4-step sequence with progressive drill sizes to drill the implant hole (Fig. 5).
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Place the implant (Fig. 6) and expand it by twisting the internal screw to 18-20 N/cm2 of torque. The expanded implant is illustrated in Fig. 7 and can be seen radiographically in Fig. 8. Note: The amount of expansion is determined by the condition of the bone.
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Install the impression sleeve on the implant/abutment (Fig 9).
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Index the impression sleeve on the adjacent teeth (Fig. 10) for transfer to the model.
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Prep the model to receive the indexed analog (Fig 11).
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Secure the indexed analog on the model with self-curing composite (Fig 12). The model is now ready (Fig. 13) to receive the pre-fabricated crown shell made of Estenia hybrid ceramic (Kuraray America, http://www.kuraray-am.com/).
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Seat the pre-machined sleeve on the abutment (Fig. 14). The sleeve serves as the crown substructure.
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The lab-fabricated crown shell is seated on the abutment, where it is finished on the model.
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The finished crown can now be placed in full function (Fig. 15). Fig. 16 is oneweek post-operative.
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Fig. 5 Progressive drill sizes are used to create the implant hole.
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| Fig. 6 The implant is placed… |
Fig. 7 …and expanded. |
Fig. 8 X-ray of placed implant. |
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| Fig. 9 Impression sleeve on the implant and abutment. |
Fig. 10 The impression sleeve is indexed on the adjacent teeth for transfer to the model. |
Fig. 11 The prepared model is ready to receive the indexed analog. |
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| Fig. 12 Indexed analog is secured on the model with self-curing resin. |
Fig. 13 Model is ready to receive the prefabricated crown shell for finishing. |
Fig. 14 Pre-machined sleeve is seated on the abutment; this will be the crown’s substructure. |
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| Fig. 15 Definitive crown is delivered in full function in the same visit. |
Fig. 16 One week after implant placement/final crown visit. |
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Clinical study
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In a two-year study conducted at the Sargon Institute (Encino, Calif.), 46 patients were consecutively treated with 50 implants that were restored with the definitive crown in a single visit. This study demonstrated a 98% success with this technique. (Data collection and analysis by Omid Ashourimonfared, MD, University of Tehran.)
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