by Paresh B. Patel, DDS | November 3, 2020
For anterior cases where uncompromised esthetics are required, dentists now have the option of using a 100% metal-free implant alternative, the ZERAMEX® XT Implant (Glidewell; Irvine, Calif.). These two-piece, all-ceramic zirconia implants offer a naturally white appearance and biocompatible tissue response that provide an optimal esthetic result, especially for patients who present with thin tissue biotypes. In the past, all-ceramic implants were mostly one-piece fixtures that, because of their design, required immediate loading. With the two-piece structure of ZERAMEX XT Implants, dentists can achieve excellent primary stability and have options for the timing of occlusal loading after the completion of the surgical procedure. Dentists will also find that the clinical technique, surgical protocol and shape of the ZERAMEX XT Implant share many similarities with a titanium implant, reducing the learning curve.
Unlike a titanium implant, however, the natural esthetics of an all-ceramic implant allow clinicians to place implants in the esthetic zone without concern of gray showing through the soft tissue. For this reason, the all-ceramic implant makes for an excellent addition to the armamentarium of the modern dental practice. The following case report demonstrates how a ZERAMEX XT Implant served as the ideal restorative solution for treatment of an edentulous site in the anterior.
Figures 1a, 1b: The patient presented for treatment of an existing edentulous site in the area of tooth #9, which was lost traumatically during childhood. The tooth had a history of unsuccessful endodontic treatment and was extracted, with a flipper provided as a temporary restorative solution. The patient preferred implant surgery in place of a bridge or a new flipper, but required optimal esthetics due to the visibility of the implant site when she smiled. Because the implant site was located in the anterior and the soft tissue was visible when the patient smiled, an all-ceramic implant solution was selected to maximize esthetics. As a metal-free, two-piece 100% zirconia alternative, the ZERAMEX XT Implant was the right choice.
Figure 2: On the day of surgery a local anesthetic was administered. After making a full-thickness flap at the implant site, I confirmed that the bone density and volume were adequate. I also confirmed that there was sufficient keratinized tissue around the implant site to proceed, and created the initial osteotomy using the ZERADRILL™ Pilot Drill included in the surgical kit.
Figure 3: After using the pilot drill, I took a radiograph of the osteotomy site with a parallel pin in place in order to confirm the angulation.
Figures 4a, 4b: After using the designated shaping drills to widen the osteotomy to accommodate a 4.2 mm x 10 mm ZERAMEX XT Implant, I used the handpiece to slowly seat the implant to the proper depth.
Figure 5: For this particular case, the implant was positioned slightly above the bone crest (about 1.6 mm). It is not necessary or recommended to bury the ZERAMEX XT Implant below the bone level.
Figures 6a, 6b: Although good primary stability was achieved, I decided not to place a provisional crown on the day of the surgery. Instead, I placed a healing cap and then sutured the site to achieve primary closure. The patient was refitted with her previous partial appliance, including modifications to ensure it did not rest on the surgical site.
Figures 7a, 7b: After a five-month healing period, the patient returned for impressions. A closed-tray transfer coping was used, and impressions were sent to Glidewell, where a zirconia abutment was customized and a BruxZir® Esthetic Zirconia crown was fabricated to achieve optimal esthetics in the anterior.
Figures 8a, 8b: On the day of the final delivery, I removed the healing cap and noted excellent healing of the surrounding tissue. The zirconia abutment was attached to the implant with the carbon-fiber–reinforced polymer VICARBO® screw.
Figure 9: The final restoration was completed successfully with delivery of the customized zirconia abutment and BruxZir Esthetic crown. No adjustments were needed.
Figures 10a, 10b: The patient was exceptionally pleased with the final result, with natural esthetics resulting from the use of the ZERAMEX XT Implant.
This case report demonstrates the straightforward surgical and restorative protocol for the ZERAMEX XT Implant. This treatment option has proven valuable in cases where the doctor wishes to provide the optimal esthetic solution, particularly in anterior cases with thin gingival biotype, where titanium implants often produce a gray shadowing.
Watch the video below to see more photos of the case:
About the Doctor
Dr. Paresh Patel is a graduate of the University of North Carolina at Chapel Hill School of Dentistry and the Medical College of Georgia/AAID MaxiCourse. He is a fellow of the Misch International Implant Institute and a diplomate of the ICOI.
Dr. Patel has placed more than 5,000 implants, has published numerous articles in leading dental journals, and has worked as a lecturer and clinical consultant on dental implants and prosthetics for several companies. He maintains private practices in Lenoir and Mooresville, North Carolina.
Dr. Paresh Patel is a board-certified Doctor of Dental Surgery. He received his doctor training at the prestigious University Of North Carolina. Upon completion of his residency, he went on to pursue advanced training in dental implant surgery.
Early in his career Dr. Patel found his passion in advanced dental procedures including dental implant placement and restoration. This passion and commitment led him to teaching and publishing many of his cases in worldwide dental journals. When Dr. Patel is not running his two office locations in NC, he is traveling around the world teaching 1000’s of dentists the advanced techniques of implant surgery and patient care.
Since 1996, he and his wife, Dr. Manisha Patel, have raised their three children in the greater North Carolina area. In his free time, Dr. Paresh is an avid aviator and enjoys flying regional with friends and family. Dr. Paresh has also developed a passion for photography including unique representations of dentistry as art. Dental Art
Dr. Paresh remains active in both state and local societies. He is honored to have the opportunity to serve and care for patients in this community.
He has a dedicated staff and treats each member like extended family. He leads his staff to care about the patients, share the same practice philosophy, and develop a passion to see growth of our practice.
Dr. Paresh Patel can be reached at:
Office: 828 754 7881 | Office address: 310 Mulberry St SW, Lenior NC, 28645
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About the Doctor
Dr. Luis A. Alicea was born and raised in San Juan, Puerto Rico. He pursued studies at the University of Puerto Rico, School of Dentistry. He then completed his Masters Degree, and Prosthodontic residency at that campus, where he focused his training in the placement, and restoration of Dental Implants. He has taught as an Associate Professor in the Research, and Restorative Departments at the University of Puerto Rico, and continues to hold privileges as a professor Ad Honorem in that institution. Dr. Alicea also completed additional training towards certification as an IV Sedation provider, at the University of Alabama, Birmingham.
Dr. Alicea is a member of the Peer Review Committee for “The International Journal of Oral & Maxillofacial Implants”, and regularly reviews articles prior to publication for this Journal. He is a also member of the American Dental Association, American Academy of Cosmetic Dentistry, American College of Prosthodontics, Florida Prosthodontic Association, American Academy of Implant Dentistry, Academy of Osseointegration, American Dental Society of Anesthesiology, West Coast District Dental Association, Hillsborough County Dental Association, and also participates in the Seattle Study Club.
Dr. Alicea has an undeniable passion, and dedication for the dental profession. He has been practicing in the Greater Tampa bay area since 2007. He likes to give back to the community and participates of Dentistry from the Heart events. He loves spending time with his wife, daughter and twin sons.