Czy istnieją granice implantacji natychmiastowej? Cyfrowo planowana i laserowo wspomagana implantacja natychmiastowa w okolicy zęba 16 z jednoczasowym zamkniętym podniesieniem dna zatoki szczękowej oraz augmentacją tkanek twardych i miękkich. Opis przypadku

Marcin Nowosielski

Streszczenie

Artykuł przedstawia opis przypadku leczenia implantoprotetycznego w oko­licy zęba 16 u 41-letniego pacjenta, u którego po wcześniejszym leczeniu za­chowawczym i endodontycznym doszło do niekorzystnego, podkostnego złamania ściany podniebiennej. Ze względu na brak możliwości uzyskania przewidywalnej obręczy protetycznej rokowanie co do odbudowy zęba wła­snego określono jako niekorzystne i zdecydowano o ekstrakcji zęba. Lecze­nie odtwórcze zaplanowano cyfrowo na podstawie badania CBCT, skanu we­wnątrzustnego oraz projektu przyszłej odbudowy protetycznej, zgodnie z za­sadą prosthetically driven implant position. Zaprojektowano dwa szablony chirurgiczne: pierwszy do kontrolowanego przygotowania dostępu pod za­mknięte podniesienie dna zatoki szczękowej, drugi do przygotowania łoża implantu i wprowadzenia wszczepu. Po atraumatycznej ekstrakcji wykona­no laserowe oczyszczenie i dezynfekcję zębodołu z zastosowaniem lase­rów Er:YAG oraz Nd:YAG. Następnie przeprowadzono zamknięte podniesie­nie dna zatoki szczękowej, augmentację materiałem typu sticky bone przy­gotowanym z The Graft oraz i-PRF, a także wszczepienie implantu IS-II acti­ve (Neobiotech) 5,0 × 10,0 mm. Ze względu na niewystarczającą stabilizację pierwotną implant pozostawiono do gojenia zamkniętego, a okolicę zabiego­wą zamknięto płatem uszypułowanym z podniebienia. Po 3,5 miesiąca uzy­skano stabilizację implantu ISQ 85 (Implant Stability Quotient), odsłonięto im­plant, przykręcono śrubę gojącą, wykonano cyfrowy projekt korony oraz final­ną odbudowę protetyczną. Kontrola po miesiącu od oddania pracy wykazała prawidłowy stan kliniczny tkanek miękkich oraz stabilny efekt funkcjonalny.

Abstract

This article presents a case report of implant-prosthetic treatment in the re­gion of tooth 16 in a 41-year-old patient with an unfavorable subcrestal pala­tal wall fracture after previous restorative and endodontic treatment. Due to the inability to obtain a predictable ferrule effect, the prognosis for restoring the tooth was considered unfavorable. Treatment was planned digitally on the basis of CBCT, an intraoral scan and the design of the future prosthetic restoration, according to the prosthetically driven implant position principle. Two surgical guides were designed: one for controlled preparation of access for closed sinus floor elevation and the other for implant osteotomy and im­plant placement. After atraumatic extraction, the socket was cleaned and di­sinfected using Er:YAG and Nd:YAG lasers. Closed sinus floor elevation, au­gmentation with sticky bone prepared from The Graft and i-PRF, and place­ment of a Neobiotech IS-II active 5.0 × 10.0 mm implant were performed. Due to insufficient insertion torque, the implant was left for submerged healing and the surgical site was closed with a palatal pedicled flap. After 3.5 mon­ths, implant stability reached ISQ 85, the implant was uncovered, a healing abutment was connected, and a digitally designed screw-retained crown was delivered. One-month follow-up showed stable peri-implant soft tissues and a favorable functional outcome.

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