Immediate, esthetic tooth replacement with the Hahn Tapered Implant System and BruxZir Anterior Solid Zirconia

The increased demand for implant therapy can be attributed in part to the improved predictability brought about by innovations in implant design. For instance, the Hahn Tapered Implant System (Glidewell Direct Europe) provides an efficient solution that simplifies implant placement for even the most challenging cases, including fresh extraction sites in the anterior. Additionally, owing to innovations in all-ceramic restorative materials, achieving esthetic results is easier than ever before.

By utilizing the most advanced implants and restorative materials, even experienced implantologists have the potential to benefit from an improved clinical workflow and results that are more esthetic. The case report that follows demonstrates immediate tooth extraction and placement of the Hahn Tapered Implant in the area of a lateral incisor. A temporary bridge, custom implant abutment, and a highly esthetic final crown are utilized to facilitate a natural-looking final restoration.
 

Case report

A 40-year-old male patient presented with no medical complications and desired an attractive smile for his business interactions. His existing implant crown in the area of his maxillary left central incisor had suffered damage, and the adjacent lateral incisor had fractured (Figs. 1a & b). The patient’s excessive parafunction was likely a contributing factor. Endodontic evaluation had determined that the lateral incisor was untreatable. The patient accepted a treatment plan in which the lateral incisor would be extracted and an implant immediately placed. Owing to its exceptional performance in immediate extraction and implantation cases, the Hahn Tapered Implant was selected for the procedure. Additionally, the damaged restoration in the area of tooth #21 would be replaced as part of the treatment plan.

To begin treatment, the non-restorable lateral incisor was extracted atraumatically (Figs. 2a & b). Removing the tooth in this manner maintained the facial plate of bone, as well as the interseptal bone that helps support the interdental papillae. A pilot drill was utilized to create the initial osteotomy approximately 3 mm apical to the adjacent cemento-enamel junction, and a 3.5 mm diameter Replace Select drill (Nobel Biocare) was used to complete preparation of the implant site (Figs. 3a & b). Because it is compatible with widely used surgical instrumentation, transitioning to the Hahn Tapered Implant System is simple. Grafting material was placed in the extraction site (Fig. 4).

The implant was threaded into place and demonstrated high primary stability (Figs. 5a & b). Maximizing primary stability is crucial in implant therapy, particularly for immediate extraction and implantation. This illustrates the reason the Hahn Tapered Implant was the ideal selection for this case. The tapered body of the implant is suitable for tight areas and sites where esthetics is important, and its prominent buttress thread and widened apex help establish excellent stability in all bone types. The dual-lead thread pattern and self-tapping grooves of the implant allow for swift insertion, and the coronal micro-threads aid in the preservation of crestal bone.

Radiography confirmed that the implant had been placed in an optimal position (Fig. 6). A transitional bridge was fabricated to minimize speech problems, help support the soft tissue, and maintain natural emergence profiles in the areas of teeth #21 and #22 during the healing period (Fig. 7). The implant site was allowed to heal for approximately four months. After completion of the healing period, the temporary bridge was removed. As expected, esthetic soft-tissue contours were revealed (Fig. 8). An open-tray final impression was taken with medium- and heavy-body vinyl polysiloxane material (Figs. 9 & 10).

Inclusive Custom Zirconia Implant Abutments with titanium bases (Glidewell Laboratories Europe) were produced by the laboratory and maintained natural emergence profiles upon delivery, a critical outcome for meeting the esthetic desires of the patient (Figs. 11a & b). BruxZir Anterior, a monolithic zirconia material specially formulated for the smile zone, was chosen for the final restoration because of its strength and lifelike esthetics. The all-ceramic material exhibits long-term durability and natural translucency, especially in combination with zirconia hybrid abutments (Fig. 12). The crown, which was digitally designed and milled using CAD/CAM technology, exhibited a precise fit. Final radiography illustrated superb bone preservation at the implant site (Fig. 13). Optimal soft-tissue contours were particularly evident around the beveled edge of the Hahn Tapered Implant, and CBCT scans confirmed ideal implant positioning (Fig. 14). The patient was very pleased with the final restoration (Figs. 15a & b).

Conclusion

The high primary stability, optimal positioning and simplified surgical protocol facilitated by the Hahn Tapered Implant make it ideal for a wide range of indications, including immediate extraction cases and restorations in the smile zone. When combined with BruxZir Anterior and zirconia hybrid custom abutments, a predictable restoration can be achieved that mimics the esthetics of the tooth being replaced.