Tooth Extraction and Immediate Implant Placement
The use of a tapered implant has several potential advantages including immediate insertion into an extraction socket. The shape of the implant more closely approximates the anatomy of many extraction sockets compared to a straight walled implant. The tapered design also lends itself to a highly stable initial fixation via a compressive fit.The Steri Oss "Replace" and "Replace Select"are 2 examples of tapered implants that are currently available.

Steri Oss
The unrestorable 2nd bicuspid was extracted and the implant was placed at the same surgical appointment. As the natural tooth root approached the sinus floor, initial stabalization was achieved with the implant engaging the sinus floor but more importantly the lateral socket walls. The selection of the implant dimensions was critical in order to achieve initial stabalization while at the same time repecting the adjacent tooth roots and as well not impinging upon the interproximal pappila.

Immediate and One Stage Placement Surgical Protocol
The immediate one stage surgical protocol minimized trauma to the patient (i.e. only 1 surgery) and to the tissues. Whenever possible this type of implant placement is done without a flap or at least with minimal soft tissue manipulation. If the implant is sufficiently stable, a 1 stage (non-submerged) placement is accomplished by immediately placing an appropriately sized healing abutment. This technique can also optimize the chances of maintaining the soft tissue anatomy (especially the pappila) and therefore optimize the esthetic result.

Screw Retained Implant Restoration
There is excellent alignment of the straight abutment and abutment scew, as indicated by the location of the screw access hole.( In general it is at the discretion of the restorative dentist as to when a cement or screw retained crown is to be fabricated). This particular surgical technique together with the tapered implant design, lends itself more often to a more ideal implant placement. This is in part due to the implant being placed prior to post extraction ridge resorption and as well the tapered implant can be ideally aligned and still be less likely to perforate the more consrticted apical third of the extraction socket.

Completed Implant Restoration - First Bicuspid
The completed restoration demonstrated a hygienic and esthetic emergence profile. The large diameter of the implant prosthetic interface (6mm) closely approximated the anatomy of the natural tooth and thus an unsightly and unhygienic overcontoured restoration was avoided. The interdental pappila were maintained as they were" supported" from the initial surgical implant insertion (via the immediate non-submerged implant placement technique and selection of an appropriately sized healing abutment) through to the final restoration.

Radiograph of the Com[pleted Restoration
The periapical demonstrated excellent bone adaptation and an excellent fitting restoration (courtesy of the restorative dentist Dr. Harvey Branicky D.D.S.and the laboratory technical specialist Mr. David Kochberg R.D.T.). In summary the use of this particular implant allowed the patient to recieve an esthetic and hygienic restoration, while only being subjected to a single appointment with local anaesthesia.

Implant Innovations (3I) Wide Diameter (6mm)
When replacing a single posterior tooth, an appropriately sized implant should be chosen in order to achieve predictable stability of the bone, implant and prosthetic components. For a molar site where there is at least 13 mm of mesio-distal interdental space, one may consider placing a 2 implant restoration. In this case the patient's ridge of almost 9mm allowed the placement of a 6mm diameter implant. The 3I coloured implant mount facilitated demarcating the mount/implant junction.

Implant Innovations (3I) Wide Diameter (6mm)
This periapical radiograph was taken 5years after completion of the restoration. The bone support and the prosthesis has been stable. There have been no incidences of component loosening. In this case the osseous anatomy allowed for the placement of a 6mm x 13mm implant. In many cases however there is a lingual undercut that cannot be diagnosed with routine radiographs. The dentist placing the implant must use clinical judgement in deciding when pre-treatment tomographs and or CAT scans are indicated. In cases where one encounters drilling resistance (due to encroachment onto the lingual cortex) a decision needs to be made if a shorter implant is indicated in order to prevent a perforation.

Steri Oss "Replace(external hex)" Wide Diameter Implant
In contrast to "straight walled" implants, the "Replace" (external hex) and "Replace Select"(internal tripod connection) are tapered narrower in an apical direction. In cases where there is an apical undercut, the tapered design will allow for the placement of an implant with the advantages of a wide prosthetic table while reducing the risk of an apical bone perforation. Once an implant is osseointegrated, the majority of the stresses are dissipated in the coronal portion of the implant/bone interface and therefore the loss of surface area (at the apical portion with a tapered implant) becomes insignificant.

Steri Oss Wide Diameter
This case was restored with a cemented crown. This particular implant design incorporates a wide prosthetic interface and an "oversized" external hex. When combined with precision fit, new scew technology, torque drivers and attention to the occlusion, the restorative dentist can feel confident to cement retain knowing it is highly unlikely that the abutment screw will loosen.

Straumann Wide Body Solid Screw (4.8mm)
Several years ITI introduced their "Wide Body" solid screw implant design. This implant originally was TPS coated but is now available with an SLA (large grit sand blasted acid etched) treated surface. The straight walled design has a diameter of 4.8mm at the body and the prosthetic interface. The implant material is Grade 4 titanium which is "cold worked" in order to impart additional strengt. ITI states there has never been a single report of a fracture of the narrower 4.1mm solid screw design.

Straumann Wide Body Solid Screw (4.8mm diameter)
The restoration in this case was cement retained. The prosthetic connection of the abutment to the implant with the ITI system is via a "morse taper" and screw. Recently ITI has introduced the "Syn-Octa" where the implants have an internal octagonal indexing system. The morse taper connection has proven to provide a very predictable connection.

Straumann ITI "Wide Neck"
The "Wide Neck" design is the newest member of the ITI family. The body of this implant is identicle to the previous "Wide Body" deesign however the prosthetic table widens fromthe standard of 4.8mm to 7.4mm. The "Wide Neck" is specifically designed for the molar replacement. This photo illustrates the implant after the healing component was removed. Not the wide prosthetic interface which helps to establish a hygienic and esthetic emergence profile to the implant restoration.

Straumann ITI Wide Neck Implant
This periapical radiograph demonstrates the excellent emergence profile and fit of the implant and restoration. Due to extensive ridge resorption, a relatively short implant was placed in order not to encroach upon the inferior alveolar canal. All the "Wide Neck" implants however are 4.8mm in the intraosseous portion and combined with the TPS or SLA surface, still impart a high enough surface area, where 8mm and even 6mm length have been consistantly successful. The unfavourable crown to root ratio encountered with a short implant is also lessened when using an implant system with a proven record for implant strength and prosthetic strength and stability (i.e. low incidence of breakage and loosening)

Crown for Straumann Wide Neck Implant
This buccal view of the crown for the "Wide Neck" implant demonstrates the wide prosthetic interface and excellent emergence profile. The internal anatomy of the crown shows the internal bevel which will interface with the external bevel of the implant. This crown has been designed to be cemented onto a solid abutment.

Dental Seminar Group (905) 882-5839