Page 52 - Dental Practice South Asia 18-6

implantology section

Manufacturing was done with Sirona CEREC Zirconia A3 meso
L block which included milling, sintering and glazing done chairside
only on Primemill & Speedfire (Figures 6A,b)
Crown was cemented extraorally over ti-base with dual-cure
resin cement.
Finally, within 1 hour chair side screw retained prosthesis was
prepared which was ready to be delivered. After final placement of
prosthesison its desired site, intraorally post-operative radiograph
was taken. (Figures 7A,b)
Patient was asked to come for timely follow-ups for 3 years, and
radiographs were taken respectively, which showed long term suc-
cess with short implants. (Figure 8)
After the 3-years of follow-up, CbCT evaluation was done to
FIG 4: Post-operative 4months radiograph and scan assess actual 3-3-dimensional bone around short implant & it was
found that uniform bone was formed without performing complex
sinus lift procedure.

DISCUSSION
One of the authors conducted finite element analysis to study stress-
es occurring at the bone-implant interface [9] . It was found that
maximum stress concentration occurred near the crest portion of
the implant surface somewhere around top 5-6mm of the implant.
Earlier implant supported prosthesis were given based on the
rationale of optimum crown/implant ratio as implant was to be
considered similar to the root of a tooth. This led to the placement
of the longest possible implants. but there is a vast difference in the
attachment of root and implant attachment to the alveolar bone.
FIG 5A: Digital model
Root is attached via periodontal ligament, whereas; implant is in
direct contact with the bone through osseo-integration.
Griffin and Cheung in 2004 recognized the maximized implant
surface area as the most contributing factor to the success rate of
short implants.[10] Romeo et al., in 2010 conducted literature
review emphasizing the significance of treatment planning on the
successful rehabilitation of short implants [11] . Implant diameter is
more effective for stress distribution than implant length and
implant geometry. Thoma et al., advised placement of short
implants in atrophic posterior maxilla as short implants reduce
patient morbidity, treatment time, and overall cost [12] . Flapless
implant surgery has been suggested as best possible treatment
option for enhancing implant esthetics, and is easy to perform. [13]
Short implant considerations can be categorized as follows:
FIG 5B: A.I (Artificial intelligence) CAD/CAM designing
a. Implant diameter: It is more efficient than length of the
pain. Antibiotics and analgesics were prescribed to the patient for 5 implant for dissipation of stress.
days. The patient was recalled after 1 week for a routine check-up; b. Crown/implant ratio: Act as vertical cantilever so good surface
there was no extraoral swelling or discomfort. The patient was and implant system with proper force orientation and load distri-
recalled after 4 months for carrying out the prosthetic procedures. bution might improve the success.
ISQ test was done again, which showed excellent biological stability c. bone quality: Act as the primary factor for the success of short
with reading measuring 84, showing excellent secondary stability. implant.
(Figure 4) d. Implant surface: As compared to smooth surface, rough
For taking impressions to avoid discomfort and save time and microtopography of surface increase the bone-implant contact
improve accuracy, we took direct impressions using the CAD/CAM thereby, accelerating osseo-integration.
technique using CEREC, Dentsply-Sirona workflow. Here in this case we opted for short implant as there was deficient
Procedure for chairside screw retained prosthesis began with the bone level so long implant could not be placed without bone aug-
use of a scanbody over ti-base. Digital model were prepared and mentation so in order to avoid this surgical procedure and looking
prosthesis designing was done chairside only by CEREC workflow at the narrow occlusal table with zero cuspal height we chose to go
with the help of Artificial Intelligence (A.I) (Figures 5A,b) with placement of short implant. Placement of implant without

52 Dental Practice // November-December 2022 // Vol 18 No 6