NobelPearl™ ceramic implants: Taking the next step – Dr Wilson Grigolli
Featured Products Promotional FeaturesPosted by: Dental Design 7th February 2019
Dr Wilson Grigolli – the first implantologist to place NobelPearl™ two-piece ceramic implants in Ireland – shares his next step as he simultaneously places the ceramic implants and performs a sinus lifting procedure.
Case report
A female patient, 41-years-old, was referred to us for the placement of ceramic implants in order to rehabilitate the upper arch from the left first pre-molar to the left first molar (24-26).
During the initial assessment an OPG was taken to determine that there was sufficient bone quality and height at the site of the 24. However, it was identified that at the site of the 26, the maxillary sinus had expanded and this indicated a sinus lifting procedure to enable implant placement. The clinical evaluation also showed a reduction of the buccal volume at the site of the pre-molars.
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Treatment planning
Considering the lack of width on the buccal bone of the pre-molars and the presence of the maxillary sinus on the site of the first molar, the surgical plan was to perform a sinus lifting procedure. We planned to use a classical Caldwell-Luc approach and graft the buccal site, simultaneously placing two NobelPearl ceramic implants. These would be a regular platform 4.2 x 12mm implant on the first pre-molar site and a wide platform 5.5 x 10mm on the first molar site. They would support a three-unit bridge following the healing period.
Surgical approach
After the anaesthetic, a full-thickness flap was raised, ensuring that the main incision remained on the ridge, with two additional vertical releasing incisions either side. A classic Caldwell-Luc sinus lift approach was performed to allow full access to the sinus cavity, and the membrane was raised by around 15mm.
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According the preconized protocol for drilling and implant placement, the first regular platform implant was placed at the first pre-molar site. The site of the first molar was also drilled according to the standard protocol. Taking extra care to protect the sinus membrane that had been raised, a large flap elevator was placed inside the sinus through the buccal opening. The second wide platform implant was then placed according to the plan. Cover screws were placed over both implants.
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A synthetic putty graft material was carefully packed onto the sinus opening to fill all the space around the implant. The same material was then placed in the buccal area of the pre-molar site to increase the ridge width and ultimately improve the aesthetic outcome of treatment.
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The flap was closed and Vicryl 3-0 sutures performed. Standard post-operative instructions were given to the patient and the implants were left to heal for three months.
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Conclusion
The NobelPearl ceramic implant features an excellent design, which facilitates a smooth surgical technique when following the manufacturer’s guidelines exactly. The ceramic implants present a reliable and efficient restorative solution and the completely metal-free option is very interesting for our clinical approach.
The main point of this particular case was to perform the sinus lift and the immediate ceramic implants placement, which is a new approach related to these implants. We do believe, based on the current literature, that the ceramic implants are reliable in all clinical situations trialled so far. The consequent natural evolution is to use them in more complex rehabilitations, such as alongside sinus lifting procedures. Despite the lack of documentation in this particular area, the predictability – in our mind – is similar to any conventional titanium implants.
Furthermore, a considerable number of patients are now looking for totally metal-free options when they require various treatments, including dental implants. This is a tendency that we cannot simply disregard, so it is very useful to have access to a reliable product that offers good clinical outcomes while fulfilling these patients’ desires.
For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com/pearl
Author bio:
Wilson Grigolli – DMD, PhD.
Specialist in Oral Surgery – Dental Council of Ireland- 16DS17
Wilson has finished the Dental School at the Sao Paulo University, in Brazil, in 1989, and since then he is focus on Oral Surgery and Oral Implantology fields, holding also a significant experience as Adjunct Professor. With a large clinical experience, more than 27,000 oral implants placed, Wilson has been working in Brazil, Portugal, and Ireland; including directly with Professor Branemark.
Currently, he is the Head Implant Surgeon at the Ratoath Dental Centre, Dental House, Dundrum Dental Clinic and McMahon Dental in Ireland, and also responsible for several clinical courses in Lisbon, Portugal, being official lecturer of Nobel Biocare Portugal.
