Straumann® Standard Plus Narrow Neck CrossFit® Implant (NNC)

Bridge construction in the anterior

tooth area of the maxilla
Steffen Wolf, Germany

Initial situation Procedure

A 67-year-old patient presented in the dental practice for Treatment planning. For optimum assessment of the ini-
implant consultation. The anamnesis revealed some spe- tial situation and subsequent treatment planning, after
cific conditions, particularly an allergy for dental met- assessing the clinical situation, a DPR diagnosis with in-
als. At this time, prosthetic restoration in the area to be traoperative assessment of the implant site was favored
reviewed consisted of an insufficient crown block in the as method of choice (Fig. 2). This would take into account
anterior tooth area corresponding with an attachment- a minimally invasive therapeutic concept of surgical
monoreducer-combination denture. Significant loosen- augmentation. Operation planning involved the extrac-
ing of the abutment teeth in the anterior tooth area was tion of nonconservable teeth and immediate restoration
found, posts and cores that had already loosened several of a Straumann® Bone Level Implant in the region. Two
times were found in the insufficiently filled root canals, implants were to be inserted in the premolar region. We
probably due to monoreducer leverage (Fig. 1). The prog- planned to expand bone with the bone spreading proce-
nosis for conservative restoration was thought to be dure and to use two Straumann® Standard Plus Narrow
extremely poor. During the consultation the patient ex- Neck CrossFit implants (NNC) made from the implant
pressed preference for an implant solution. The patient material Roxolid® if the transversal bone at the site was
also specified a cost limit. compromised. Prosthetic restoration must fulfil the re-

Fig. 1 Fig. 2 Fig. 3

Fig. 4 Fig. 5 Fig. 6

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quirements of an allergy free dental prosthesis. The pros- autologous bone chips gained here were later used for im-
thetic construction was to be manufactured with the plant augmentation in the central left incisor area. Once
Straumann Cares System in the in-house dental master the implant site had been carefully prepared by means
laboratory. of bone spreading (Fig. 4) and the final implant cavities
drilled, the prepared bone was meticulously examined
Surgical procedure. Due to the impaired vasoconstric- with a bulbous probe and gauges from the Straumann
tion, anaesthetization was adrenaline-free with local surgery set. Two NNC implants were then inserted in the
anaesthetic and one subsequent injection during the op- controlled, intact bony structures (Fig. 5). The NNC im-
eration. Extraction of the middle and left lateral incisors plant 3.3/14/SLActive® was inserted in the region of the
was without complication. A central crestal incision was first premolars, the 3-mm reduced height NNC healing cap
made with little crestal bone denudation and no relief was used for both the implant seal, as well as for primary
incision. The anticipated reduction of the transverse bone soft tissue conditioning. We decided to use NNC implant
then became clearly visible and, as method of choice, the 3.3/12 NNC/SLActive® and the identical 3-mm closure
bone spreading procedure and two NNC implants were screw for the region of the second premolars. Once this
performed (Fig. 3). The insertion site in the region of both stage of the operation was complete, alveolar implant res-
left premolars was prepared by manually shaving the toration in the central anterior tooth area was performed.
bone until an even bone plateau had been created. The The immediate implantation of a Straumann bone level

Fig. 7 Fig. 8 Fig. 9

Fig. 10 Fig. 11 Fig. 12

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implant with the dimensions 4.1/10 which is fitted with implant (Fig. 6). Intraoperative haptic assessment of the
the 0.5-mm RC closure screw was then performed. The various fixations of the implant insertion aids was easily
alveolar walls were undamaged, primary implant sta- possible (Fig. 7). To assess postoperative treatment success,
bility was given. As a sufficient amount of autologous in particular with regard to adequate peri-implant bone
bone chips had been gained from maxillary crest level- coverage, a control DTV was made on which the correct
ing in the premolar area, this was used as volume filler implant-bone relation could be verified. This meant addi-
for alveolar augmentation. The distance between the tional augmentation measures could be safely dispensed
body of the implant and the alveolar wall that required with (Fig. 8). Perioperative medication included antibiotic
augmentation was 1 – 2 mm. Augmentation was vertical endocarditis prophylaxis; the patient was also given post-
with slight overlap by means of a platform switch at the operative pain medication for one day.
implant shoulder. Alveolar restoration of the lateral in-
cisor was performed using collagen matrix. Suture clo- Prosthetic restoration. Following integration of a provision-
sure in the area of the anterior tooth implant resulted in al denture and a complication free healing time, individual
complete coverage of the augmentation area, the closure gingival architecture then was performed in the anterior
screw lay only minimally exposed approx. 3 mm below tooth area. To facilitate continued wearing of the provi-
the mucogingival soft tissue. Soft tissue closure at the sional denture during the gradual process of soft tissue
NNC closure screw supported transgingival healing of the conditioning, our dental laboratory prepared and short-

Fig. 13 Fig. 14 Fig. 15

Fig. 16 Fig. 17 Fig. 18

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ened an RC temporary abutment with hard polymer plastic, individualized to
the area of the soft tissue profile (Figs. 9 – 11). The impression for the individual
incisor abutment was made with a gingiva-former on the basis of an RC im-
pression post to match the individual impression post. The NNC implants were
incorporated into the impression (Fig. 12) with the ready-made NNC impression
posts. On account of the patient’s allergy and in consideration of the esthetic
aspect, in addition to titanium abutments (Fig. 13) it was also decided to use a
zirconium-based bridge framework with ceramic veneering (Figs. 14, 15). The
titanium abutments and zirconium bridge were constructed virtually in CAD-
CAM procedure with the Straumann CS2 scanner in our own dental labora-
tory and the framework was made at the Straumann Milling Center in Leipzig.
Because of the interocclusal distance, the decision was to use an anatomically
formed zirconium morsal surface, which could be optimally prepared with Steffen A. Wolf
the Straumann® CARES® system processing software during the construction Dr. med. dent., [Link]. (DGI)
phase. In consideration of the esthetic aspect, the individual veneer was mostly
in the vestibular region (Figs. 16, 17). Postoperative x-ray control confirmed cor- Attainment of the degree of Doctor
rect positioning of the prosthetic components (Fig. 18). of Dentistry in 2000 from the Clinic
for Oral and Maxillofacial Surgery at
the Free University of Berlin headed
by Prof. B. Hoffmeister. Since 2000
Conclusion working in own private practice in
Halberstadt/Germany. Received the
The patient is extremely satisfied with both the result and the cost-effect rela- degree of Master of Science in Oral
tion. Appropriate design of the emergence profile, the titanium abutment and Implantology in 2010.
the zirconium bridge entirely fulfil the esthetic requirements of the visible
areas. In the event of later loss of the second molars the patients wishes to [Link]
undertake prosthetic restoration of the ensuing end gap situation. As shown praxis@[Link]
here, in cases of compromised bone and in consideration of the esthetic zone
and CADCAM-made elements of different materials, the use of NNC implants David Szymanska
can lead to very positive results. ZTM / Praxislabor

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