Posterior restoration simplified by one-piece implant

Patient expectation continues to increase with the pervasiveness of implant treatment. The routine and frequent use of dental implants to replace missing teeth is accompanied by expectations not only limited to function and aesthetics but comfort and time spent receiving treatment. A case study detailing the replacement of an unrestorable maxillary premolar describes a short, simple, and cost-effective treatment option for replacing an unrestorable premolar tooth with a one-piece implant. Dr Blackie Swart, implant specialist in private practice in Cape Town, South Africa, explains the importance of the clinical report.

Question: Briefly give some background on the one-piece implant.
Blackie Swart: The one-piece NobelDirect posterior implant has a tapered design which makes it possible to avoid any soft tissue manipulation after initial healing. It thus has no microgap. It is part of the NobelDirect implant range, but it has quite unique features, such as a snappy abutment which means no preparation is required on the implant.
 

I have been using this posterior implant since 2005 and have had very good results with it. In fact, I have only lost two implants, both on my learning curve. The first case I felt would heal better without the protective cuff of the snappy abutment and the patient unscrewed the implant with his tongue within 24 hours. This was due to the grooves of the snappy abutment, giving a purchase point for the tongue to turn the implant. In the second case, the implant was placed in an extraction socket and I suspect some occlusal disturbances took place in the healing period. This implant is now the standard in my practice to replace teeth in the posterior of the mouth.

Question: You describe your case as a “short, simple and cost-effective treatment option”. Can you provide more detail on how a one-piece implant does this?

Blackie Swart: My clinical report focused on the replacement of a first premolar, thus in the aesthetic area where you would definitely use a straight abutment. With this being the limits of use of this implant - it made for a good clinical report. This patient’s rehabilitation proves the stability of both hard and soft tissue in the longer term.

I extracted the tooth, placed the implant and provisionally loaded the implant in the same session. With this approach savings are made for the patient on the amount of chairtime to complete the treatment and a reduction in time away from work. The hardware costs for the implant are also cheaper.
 

With the snappy abutment correctly placed in all 3 dimensions, established at surgery, the prosthodontic rehabilitation is general quite simple because impression taking with a snap-on impression post is fairly straightforward.

Question: Are there are any special considerations for the implant site preparation with a one-piece implant?

Blackie Swart: The correct placement of the implant is not easy and this should be performed by an experienced implantologist. If the prosthodontic phase is not done by the same person that places the implant, the surgeon should have a sound basis of the prosthodontic principles, as the site preparation for the implant determines the prosthetic outcome.
 

Blackie Swart: The prosthodontic phase is very easy and straightforward. I do the surgery for some inexperienced dentists that are new to implants. In these cases it is the ideal implant to use. I have had many phone calls thanking me for the simplicity of the restorative phase. The bone remodelling also seems extremely stable and I am investigating if this is due to the minimal widening on the implant neck created by the snappy abutment, or the depth of placement.

Question: What are the current outcomes relating to long term bone resorption with these cases?

Blackie Swart: I have done some research but unfortunately I made no distinction between the NobelDirect and the NobelDirect Posterior implant. 82% of the implants however were posterior implants and the results were very favourable (1.1mm bone remodelling after 6 months or longer). At present I am looking at this group of implants exclusively as part of a long term follow up. The first reading is being read independently at the moment. This study will continue for four years.
 

Blackie Swart: Multicentre scientific evidence as well as further research is always a prerequisite to establish a treatment modality in modern day practice. We live in an evidence-based clinical environment. The studies are ongoing and time is the master of proof. As far as I know there is no study or paper exclusively on NobelDirect Posterior implants. These publications were always incorporated into the NobelDirect group. I feel this implant has its own characteristics and results quite apart from the NobelDirect group. For an implant to be successful it should however also be predictably successful in the hands of all experienced surgeons. With the evidence available in the present literature, this implant can surely already be considered a viable treatment option in any implantology practice.

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Full article
‘Simplifying the implant treatment for an unrestorable premolar with a one-piece implant: A clinical report’ Journal of Prosthetic Dentistry
Volume 100, Issue 2, August 2008, Pages 81-85