Introduction
The advent of dental implant has made it possible
for patient to liberate themselves of conventional crown and
bridges as well as removable dentures. However, implant treatment
has its inherent disadvantages as well. Since conventional
implants will need some time for it to osseo-integrate, these
conventional implants will need to be protected from the everyday
occlusion. Therefore dentures or temporary Maryland Bridge
will be a natural solution for these cases. Most of the time,
it will mean dentures, which could be the very least annoying
to the patient or at worst, a social embarrassment for them.
The Alternative System
The one piece dental implant would be ideal
in this case. However choosing the right type of implant as
well as careful case selection is paramount in insuring a
successful outcome. The implant system must give good primary
stability as well as easy to restore immediately after surgery.
The advantage of a one piece implants is that it has no interface
between the abutment and the main fixture, therefore this
will eliminate the problem of micro-gap an screw loosening
of the implant, The argument of biological width and wether
to have “platform switching” procedure will disappear. However
there are inherent disadvantages which will be discussed later.
A Case Report
A 36 year old female who came to our clinic
from overseas needed implants to restore to missing teeth
on the right upper quadrant. There was a residual tooth still
left in the second premolar region.
An impression was made of her upper and
lower teeth and was poured in stone. Two teeth were waxed
up where the proposed implantation should be.
Surgical Phase
On the day of surgery, the patient was prepped
accordingly. Local anesthetic was given, and the root of the
second premolar was promptly removed. A flapless surgery was
decided as the best option and the patient . Two single stage
one piece implants (ICP Implant, Turin, Italy) were placed
with no mucosal flap raised. The advantage of this procedure
is that there is:
1. No periosteum is raised therefore post-operative pain is
at its minimum
2. Less bleeding
The implant abutment is then prepared
like any normal crown. Note the picture above (Fig 3) was
taken not more than 20 minutes after the implants were surgically
placed. What is notably missing is any form of bleeding from
the op site.
The new implants were promptly radiographed
to make sure that it is properly placed and no vital structures
have been breached. 
Note that the implants were placed nicely in the space available. Care is taken not to interfere
with adjacent root of teeth or the sinus space above
Prosthetic Phase
A silicone impression was taken of the waxed up model to make a provisional crown of the above case.
The silicone impression was then placed back into the mouth to be fitted into the occlusion with a temporization material
(Protemp, 3M, USA)
The temporized crowns were adjusted to the occlusion as well polished to a fine finish.
The patient was then given appropriate antibiotics
and analgesics and was sent home with provisional teeth placed
on the newly placed implants.
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