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Special Issues
July/August 2018
Volume 39, Issue 3
Peer-Reviewed

Smile Without Fear: SmartFix® Concept for Oral Rehabilitation

Anthony Ramirez, DDS

3D dentistry is truly transformative. By integrating computer-assisted implantology via GALILEOS® CBCT imaging (Dentsply Sirona Imaging, dentsplysirona.com) clinicians can confidently offer streamlined solutions for complex dental problems and provide advanced treatment options. Dentsply Sirona’s innovative SmartFix® concept affords implant dentists unique, reliable rehabilitation possibilities. The Astra Tech EV drilling protocol ensures primary stability for implant placement when immediately loading. Use of a digital workflow to diagnose and treatment plan removes guesswork, provides predictability, and ensures precision to return esthetics and function. The Profile EV implant, designed to follow the geometry of the alveolar ridge, decreases the need for bone reduction when tilting posterior fixtures by placing them at or slightly below the crestal bone. Restorative product options provide expanded choices with regard to angulations, tissue depths, and interocclusal spaces. Available prosthetic products simplify the restorative process for converting an immediate denture to an implant-retained fixed provisional prosthesis during the “teeth in a day” treatment procedure. As shown in this case, the patient gains expeditious improvement in esthetics, speech, and function with a single-staged, immediate-load, fixed hybrid prosthetic solution.

KEY Takeaways

Proper planning in 3D imaging software reduces the complexity of challenging treatments. CBCT imaging is foundational for complete examination and comprehensive treatments. A flapless guided implant approach reduces postoperative sequelae.

The Profile EV implant is designed to minimize marginal bone remodeling and improve crestal bone preservation, lessening the need for bone augmentation or reduction and enhancing postoperative healing.

Combining the Profile EV implant with planning software and using surgical guide safeguards enables precise placements with improved control of depth, angulation, and timing. The SmartFix concept streamlines all-on-4 oral rehabilitation.

About the Author

Anthony Ramirez, DDS
Private Practice
Brooklyn, New York
Attending Physician
New York Presbyterian Brooklyn Methodist Hospital

Fig 1. Clinical preoperative intraoral presentation of patient’s dentition

Figure 1

Fig 2. GALILEOS implant plan for all-on-4 protocol with distally tiled posterior implants to extend A-P spread.

Figure 2

Fig 3. Axial 3D (axial3d.com) skull image of the expected implant sites and trajectory of each fixture (rendering in GALILEOS implant planning software).

Figure 3

Fig 4. Simplant Safe Guide (Dentsply Sirona) scan with a design for six possible implant sites.

Figure 4

Fig 5. Clinical view immediately after flapless guided implant surgery, extractions, and grafting completed for sockets Nos. 6 and 8 and around voids for immediate implant No. 9, which is two-staged.

Figure 5

Fig 6. Implant No. 4 with multibase abutment body torqued in at 25 Ncm. SmartFix system (Dentsply Sirona) utilizes a two-part body and head for angled multibase abutments, which creates a common path of insertion for the prosthesis. A multibase abutment head would subsequently be inserted into the abutment body and torqued in at 25 Ncm to receive a temporary cylinder connecting the prosthesis to the implants. Implants Nos. 4, 7, 11, and13 received abutments.

Figure 6

Fig 7. Panoramic postoperative radiograph of SmartFix concept. Three Profile EV implants were used and four abutments were attached during a single-stage surgery. The immediate implant placed in the No. 9 extraction socket was grafted in a two-stage approach.

Figure 7

Fig 8. 3D skull view of the right maxilla depicting implants Nos. 4, 7, and 9 immediately after placement. Note distally tilted implant as part of all-on-4 protocol.

Figure 8

Fig 9. Actual cross-sectional image of implant No. 7 with a straight multibase abutment, well-positioned within bone and using sloped implant to maximize existing bone anatomy. Virtual implant is superimposed over actual fixture.

Figure 9

Fig 10. Cross-sectional 3D image of implant No. 13 immediately after placement, after the area of the previous radiolucent lesion had been excised, grafted, healed, and planned with a virtual Profile EV implant. Note how well the implant follows the virtual plan. Each implant was placed with precision.

Figure 10

Fig 11. Periapical transverse image of Profile EV implant placed in site No. 13, with slope of implant precisely positioned toward the mesial as per the SmartFix concept, fitted with a multibase abutment. Osstell IDX (osstell.com) recording of this implant’s stability quotient was 75, which is an objective value, indicating that the implant was installed with high primary stability and was suitable for immediate loading.

Figure 11

Fig 12. Occlusal view of flapless guided implant surgery completed for implants Nos. 4, 7, 11, and 13 with multibase abutments and grafting of No. 9 two-staged.

Figure 12

Fig 13. Provisional prosthesis inserted. The prosthesis was esthetic, fixed, and functional allowing the patient to smile and speak without fear.

Figure 13

Fig 14. At 3 months, esthetics and function were maintained. Each implant was stable with marginal bone levels maintained, per radiographic evidence (not shown). The small gap between the prosthesis and ridge is evidence of remodeling of post-extraction sites. A definitive prosthesis will be fabricated with proper contours for the newly established anatomy.

Figure 14

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