Dr. Roy Leshem DDS

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Dr. Roy Leshem shows a technique to replace a single tooth with an implant-borne zirconia crown.

How to: Replace a single molar with an implant

 by means of a dental implant and single crown prosthesis is a challenging procedure.

	There are several possible prosthetic failures: a loosening and/or fracture of a prosthetic screw, a fracture of the implant or food impaction and the difficulty of maintaining oral hygiene due to altered emergence profile. 

The high rate of prosthetic failures are due to the large mesiodistal and bucolingual aspect of a molar compared to the size of an implant.

Product roundup: The latest in dental implants

	Material fatigue is created by the large occlusal forces on a molar crown when connected to a regular platform implant. It is difficult to fabricate a crown with the natural emergence profile of molars on a regular platform implant. 

	Placing a very wide diameter implant can overcome these failures, but this is not possible in most cases as the ridge is often resorbed following the loss of tooth and the bucolingual dimension does not enable placing a wide diameter implant. The following case report presents how these drawbacks can be overcome by using a 5 mm diameter implant with a tissue-level 6.5 mm platform.

	The 6.5 tissue level platform enables the creation of an anatomic emergence profile without the need for a deep subgingival crown.

Must read: Are digital impressions REALLY the best choice?

	A prosthetic screw and implant can bear the occlusal forces as the platform is wider. The crown is well seated on the implant’s shoulders and the height is smaller compared to using a bone level implant.

	A WIDE PLATFORM TAPERED TITE FIT 5 mm thread (

	Fabricating a direct, screw-retained zirconium crown provides the ultimate esthetics, hygiene and flexibility. 

	Click the next button to go step-by-step ... 

Fig. 1 X-ray of tooth demonstrating lesion around mesial root.

	A 51-year-old female patient had her lower first left molar extracted due to a vertical fracture of a root (

	Two months later, the extraction site was prepared for placing an implant (

Fig. 3 WIDE PLATFORM TAPERED TITE FIT 5 mm implant (HI-TEC IMPLANTS)

	In order to achieve the required result, a WIDE PLATFORM TAPERED TITE FIT 5 mm implant (HI-TEC IMPLANTS) was selected (

	Drill sequence was completed with 4.2 mm Final bur (

	The implant was inserted and minor bone augmentation was performed (

Fig. 7 Bone augmentation and 1.5 mm Healing cap.

	Six weeks later, an impression was taken (

	A screw-retained direct zirconia crown was fabricated and placed (

Fig. 14 Abutment for screw-retained crown.

	The esthetic zone is always a challenge for implant restoration. The problem of losing gingival height following extraction jeopardizes achieving the natural look of the crowns placed on the implants.

Bone defects surrounding the tooth prior to extraction add additional complication to the treatment as, in most cases, the bone will not regenerate following extraction of the tooth and, as a result, there will not be sufficient bone for placing an implant and for achieving the desired esthetic result.

 offers a wide range of implant systems plus compatible implant systems that do not require dental clinicians to invest in additional surgical kits. HI-TEC is in close contact with dentists and is dedicated to addressing their needs in a short period of time.

In fact, the company was founded by dental professionals with clinical experience who look forward to an ever-expanding market as more and more dentists offer implant services. Usage is increasing across all categories of implants, and dentists interested in placing implants should start learning about the variety of options and solutions HI-TEC offers, and solve each case with the implant that is ideal for the situation.

In this particular case, a tapered self thread implant was used in an esthetic zone for an implant restoration in a site with bone defect.

A 42-year-old male patient had his first upper pre-molar tooth extracted due to a vertical fracture of the buccal root. This left a perforation of the buccal plate. 

The treatment chosen for the rehabilitation of the missing tooth was to place a wide platform tapered 4.20mm implant simultaneous with bone augmentation and to construct a porcelain crown using a zirconium abutment for building the porcelain directly bonded to it.  

from HI-TEC Implants was selected as most suitable for achieving initial retention in the bone defect and as the wide platform has the closest fit to the socket.

In order to achieve the ultimate esthetics, the accurate positioning of the implant is essential as well as meticulous soft tissue management.

 The surgery was performed 6 weeks after extraction. 

 shows the site prior to surgery. A full flap was opened, exposing the large crater and the perforation of the buccal plate (

A 2.0mm pilot drill was used to drill beyond the depth of the socket (

) and was followed by the drill sequence until the 3.65mm final drill for 4.20mm implant.

The final drill was used to evaluate the accurate position and angulation of the preparation (

). A Self Tapping 4.20mm diameter 13mm length Tapered Self Thread Implant was inserted (

A cover screw was placed on the implant (

). The buccal bone defect and the space between the implant and socket were augmented with bone and were covered by a resorbable membrane (

The flap was sutured covering the entire augmentation (

). Figure 9 shows the site after healing.

Four months later the implant was exposed, positioning the flap buccally in order to achieve attached gingiva (

) was used to fabricate a crown by bonding porcelain to the zirconium taking into account that the crown creates the required gingival contour (

The crown was connected directly to the implant, the connecting screw was tightened and composite closed the top of the screw (

HI-TEC Implants has been developing, manufacturing and marketing an extensive range of dental implants and prosthetic elements since 1990. The company was founded by dental professionals with rich clinical experience and its commitment is to develop products that offer long term compatibility with implant dentistry. The goal is to continue to provide the most technologically advanced products to help dentists develop their practices in order to provide their patients with the most up-to-date treatment.

This case illustrates how using a 4.20 mm Tapered Self Thread from HI-TEC Implants is most suitable for achieving initial retention in the bone defect and as the wide platform has the closest fit to the socket. 

This article originally appeared in the June 2014 issue of Dental Products Report. For more great articles about products in action, click here to subscribe to 

 The esthetic zone is always a challenge for implant restoration. The problem of losing gingival height following extraction jeopardizes achieving the natural look of the crowns placed on the implants.  

How to restore implants with a tapered self thread implant

 lost the post and crown on premolar No. 45 because of decay. The treatment plan called for the extraction of the root to immediately place an implant in the socket. The patient insisted on receiving an immediate provisional restoration and it was decided to place an abutment and a provisional crown immediately after surgery, rather than prepare a removable restoration that interferes with the healing of the site.

To achieve the required stability and adaptation to extraction site, the EXPERT 5.00 implant (HI-TEC IMPLANTS) was selected because of its root form that fits the extraction site and wider apical threads that provide initial stability (

In addition, EXPERT’s platform-switching feature helps preserve the bone level. 

), and a 2 mm round bur was used to achieve the correct direction of preparation, after which a 2 mm drill was used to reach determined depth.

Preparation continued until the final drill of diameter 4.3 mm (

EXPERT 5.00 length 11.5 mm (HI-TEC IMPLANTS) was inserted (

), and a 2 mm shoulder height abutment was placed on the implant (

) before the flap was sutured around the abutment. The acrylic crown was prepared and cemented with temporary cement (

Two months later the impression was taken and a PFM crown was prepared and cemented.

Simplifying the implant process with Hi-Tec Implant's EXPERT 5.00 implants.