Z-SYSTEMS Tissue Level Implant Training
On Demand

Tissue Level Training: 2 Screw-Retained Zirconia Implants Placed at Sites #12, #14 to Provide a Lifelong Implant Foundation

Dr. Ted Fields
4 minutes
In this video, Dr. Fields shows and explains the rationale behind his decisions when renewing this patient's smile.

Full Case Summary: We removed 5 teeth: teeth #12, 13, 14,15, and 18. After three months of healing prior to implant placement, we developed an implant strategy that saved this patient a whole lot of money while giving him a high-quality result. Given his occlusion and the nice bone height and width available, we replaced only 2 of these teeth rather than all 5, while providing what should be a lifelong implant foundation for his occlusion. Dental implant tooth replacement doesn’t have to be a ridiculously expensive treatment option, even as with this patient if it is their only reasonable option. So, this is a great strategy to provide cost-effective implant treatment when conditions allow.

For this patient, we took the unusual step of placing a wide-diameter implant in the premolar position as well as in the molar position. Note: we are treating this as if the patient had a first premolar extraction for orthodontic purposes, and our intent is to restore these as a second premolar and a first molar, for maximum occlusal chewing surface with just two implants. Typically, 4mm diameter implants are much better suited for the replacement of premolars, and often a wider implant will not safely fit between adjacent teeth. Here, however, we had no distal tooth, so we had the latitude to adjust the position of the distal implant according to the spacing needs of the premolar implant.

A look at the CTs makes it clear that we have enough bone for a 5mm diameter implant in both of our desired implant positions. 10mm length implants are plenty safe without unnecessarily challenging the maxillary sinus. So, both implants selected are 5mm x 10mm Z5TL Z-Systems all zirconia implants. Since these are tissue-level implants, both were placed at the tissue level, not exceeding 35Ncm of implant insertion torque. If additional torque is required for placement, the implant should instead be removed and the implant osteotomy modified to accommodate a more moderate insertion torque at the proper implant placement level. Since this patient also had plenty of attached gingiva, we made the decision to go with a more atraumatic procedure and place these implants using a flapless technique. I would consider a flapless implant technique a much more advanced and difficult technique than one in which a flap is reflected. So this should not be a default procedure for doctors uncomfortable incising and reflecting proper flaps or unfamiliar with the proper suturing technique.
Included in this Video:
All technical specs including drill speeds and torque levels for each step in the process.
Full Summary of Dr. Fields' rationale for his decision-making throughout this case.
Meet Your Instructor

Dr. Ted Fields

Dr. Ted Fields graduated from Emory University in Atlanta, Georgia, with a degree in mathematics and computer science. He then received his dental degree from Baylor College of Dentistry, his certificate in Oral & Maxillofacial Surgery at the Baylor University Medical Center, and a PhD in Craniofacial Biology from the Texas A&M Health Science Center. He started his own dental implant-focused oral surgery practice more than 15 years ago and has continued to push the boundaries and contribute to improved implant care ever since. Dr. Fields has published numerous original peer-reviewed manuscripts, clinical reviews, and several book chapters. He has won numerous professional honors and awards; is an active member of many professional organizations; and has a very active lecture schedule throughout the world focused on various aspects of dental implants and implant-related surgical procedures. His professional goal is to leave the practice of dentistry better than when he started. He tries to do this every day by sharing his knowledge, enthusiasm, and passion with other professionals and patients alike. This goal also includes working to develop new techniques, protocols, teaching materials, and surgical devices and instrumentation that facilitate better patient care. In short, Dr.Fields loves what he does, and wants to pay it forward to benefit as many people as possible. Dr. Fields has been placing ceramic implants for more than 10 years, which is the most extensive experience of anyone in the United States. He has helped design several generations of ceramic implants and implant components, and continues to work in this capacity. He tracks every patient and uses outcome assessments to improve the practice of ceramic implant dentistry. These observations, along with his seminars and over-the-shoulder courses have helped bring recognition and improvement to ceramic implant dentistry.

Dr. Ted Fields, Clinical Director | DDS, OMS, PhD