Narrow diameter dental implants are proven to be an excellent addition to our armamentarium to treat cases where the space is limited or where the bone availability is restricted.

One of the biggest concerns with narrow diameter implants is the fracture of the implant due to its reduced diameter and occlusal load exerted intraorally. Straumann recently developed the BLT ∅ 2.9 mm, which has the advantage of being fabricated with Roxolid – a metal alloy composed of 15% zirconium and 85% titanium that has higher tensile and fatique strengths than comparable titanium implants, and has excellent osseointegration and biocompatibility properties.

This visual essay walks you through an immediate implant placement and fabrication of a definitive ceramic restoration of a maxillary lateral incisor. The implant was the treatment of choice as the coronal portion of the tooth was fractured and presented extensive breakdown, lack of ferrule and inadequate structural integrity.

Occlusal and frontal view of the fractured maxillary right lateral, note limited mesiodistal space measured in the periapical radiograph.
Extraction was performed with minimal trauma to the surrounding tissues utilizing the Benex system.
Initial drilling was performed and the guide pin was placed to confirm the implant position.
Straumann BLT 2.9 x 14 mm was placed.
Customized healing abutment was fabricated with composite resin to maintain the surrounding tissue architecture.
Frontal and mesial view of the customized healing abutment.
Connective tissue harvested from the palate was grafted in the area to improve the site utilizing the tunneling technique.
BioOss collagen was grafted in the gap area to improve the site.
Frontal and occlusal view of the healed area 3 months after implant placement, note how the gingival architecture was maintained.
Customized impression coping was fabricated to transfer the gingival topography to the master cast.
Screw retained provisional restoration. Note the critical and sub-critical contours.
Screw retained provisional restoration on the master cast.
Screw-retained provisional restoration seated intra-orally and the screw access hole was obliterated with Teflon tape and composite resin.
Final design of customized zirconia abutment bonded to Straumann Variobase and porcelain layered zirconia crown.
Frontal and occlusal view of the final gingival architecture.
Customized zirconia abutment and final crown cemented temporarily in place.
One month post-operatory of the implant-supported crown on the right maxillary lateral.
Frontal view of the patient's smile three months after crown insertion.
Periapical radiograph and CBCT image three months after insertion.

Narrow diameter implants are a great solution for limited spaces and adequate esthetics can be achieved when they are used properly.

As evident in these photographs the clinical crowns of the central incisors are shorter than the lateral incisors. The patient was advised to go through an esthetic crown lengthening procedure performed on her central incisors, which she refused.

Note: Roxolid® and Variobase® are both registered trademarks of Straumann Holding AG.

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.

Citations

Medvedev A, Molotnikov A, Lapovok R, Zeller R, Berner S, Habersetzer P, Dalla Torre S. (2016). Microstructure and mechanical properties of Ti-15Zr alloy used as dental implant material. Journal of the Mechanical Behavior of Biomedical Materials, In Press, Accepted Manuscript, Available online 11 May 2016.