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New implant concepts are pushing the industry further forward toward streamlined digitization and fully customized implant fixtures as well as new materials for restorative solutions. Here is just a smattering of what is coming or has been newly introduced.
Replicate Tooth Root Implant
A revolutionary implant fixture approach that will be coming to the United States early in 2012 from Natural Dental Implants (NDI) (www.replicatetooth.com) is the company’s patented Replicate Non-surgical Tooth Replacement System. Indicated only for single-tooth replacement, the process begins prior to tooth extraction. Using data collected from a CBCT scan and PVS impression of the tooth crown, the company’s laboratory, located in Germany, computer-designs a patient-specific replacement tooth fixture using proprietary CAD software. The implant root base is an exact replica of the tooth to be extracted, including the abutment and crown design from the digitized impression. The anatomically exact components are CAM-manufactured from either titanium or alumina toughened zirconia (ATZ) with the implant fixture base and abutment delivered as a single component along with the glass–ceramic temporary crown positioned out of occlusion. The titanium or ceramic root base and abutment are fused together to ensure the esthetics of the finished tooth are not compromised close to the gingival margin and to eliminate any subgingival gap where bacteria can accumulate.
“In developing this implant our primary goal was to find a way to immediately replace an extracted tooth and lower the risk for the surgeon in terms of placement as well as make it more convenient and less traumatic for the patient,” says Lea Nesbit, CEO. “This process also reduces risk of infection at the site.”
The Replicate Tooth is placed in the extraction socket immediately after extraction of the non-functional tooth and a customized titanium splint designed to the patient’s lingual anatomy is delivered already attached to the crown. The splint provides primary stability and placement accuracy during bone integration. Once the bone has healed, the splint is removed.
“In the past, companies have tried to copy the tooth root and press fit the implant,” says Nesbit. “But, if you put pressure on that bone, it will actually deteriorate. That is why we make sure there is enough space between the bone and the tooth root so that the root fixture hangs loose in the socket and the space fills with blood. The splint holds that root in place while osseointegration takes place over a 3- to 4-month period.” The restoring dentist can then either work with their preferred laboratory to fabricate the final crown or order it from NDI.
Pictures 1-4 represent the Replicate Tooth Implant.
Coming to the market soon is the ClearPlant implant fixture concept from Espritdent (www.espritdent.com). Proven to minimize bone and tissue loss by eliminating micromovement and subgingival microgap, the fixture is said to preserve the integrity of the bone surrounding the coronal aspect of the implant. The implant system comes with an advanced tissue forming system that shapes the tissue during the osseointegration phase to achieve an esthetic restorative outcome and ties into chairside intraoral impression scanning via a scan jig. In the near future, software advancements will allow the restoring dentist or surgeon to scan the implant fixture.
Pictures 5-12 represent a step-by-step case restored using the ClearPlant system.
3M ESPE is introducing Lava Ultimate, a new CAM milled resin nano ceramic material that is tough, durable, and kind to opposing dentition (Figure 13). Its shock-absorbance characteristic is well suited for implant crowns. Backed by a 10-year warranty, the material is reported to be easy and fast to mill and polish and requires no firing after the milling process. Currently the material is available for the CEREC and E4D milling units.