A 50-year-old female, healthy, non-smoker visited our dental office seeking for a tooth replacement in the posterior zone. Tooth #46 was extracted several years ago. At the clinical examination, the patient was considered periodontally stable with sufficient soft and hard tissues at the future implant site (Fig. 1). To confirm this, a radiographic examination was performed and showed an adequate bone availability for the placement of a standard-length implant (Fig. 2).

Treatment planning

Due to the favorable height and thickness of the ridge observed in the clinical and radiographic evaluation, it was decided to insert a Straumann® BLX Implant ∅ 4.5 mm - Regular Base -SLActive® 10 mm. Roxolid® with a free-hand approach. Prior to surgery, the patient underwent a prophylaxis protocol based on Amoxicillin 2gr (1 hour before) and Nimesulide 100 mg (half an hour before). Moreover, the patient was educated regarding the importance of maintaining good oral hygiene and was instructed to rinse with 0.12% chlorhexidine solution daily for 30 seconds one week before and after the planned date of surgery.

Surgical procedure

The surgery was performed under local anesthesia with 2% lidocaine with 1:100,000 epinephrine. The freehand surgery involved making a mid-crestal incision at the implant recipient site, sulcular incisions on the side of the surrounding teeth, and elevating a full-thickness flap (Fig. 3). A Straumann® BLX Implant ∅ 4.5 mm - Regular Base -SLActive® 10 mm. Roxolid® was inserted in #46 following the manufacturer's instructions (Fig. 4). The healing abutment was screwed, and the complete seating of the healing abutment was verified radiographically (Figs. 5-6). Lastly, the flap was closed with 5-0 Nylon interrupted sutures.

The patient was instructed to rinse with 0.12% chlorhexidine solution twice a day and take NSAID as needed. Antibiotic was discontinued, and sutures were planned to be removed seven days following the surgery. At the suture removal appointment, healing was noticed to be uneventful.

Prosthetic procedure

Six weeks after surgery, the patient returned to the dental office. After confirming stable osseointegration, the healing abutment was removed, and a Straumann® CARES® Mono Scanbody was selected and screwed in the implant with a torque of 15 Ncm to obtain an intraoral digital impression. Acquired data was sent to the laboratory, and STL data were forwarded to a milling center. The final prosthesis was delivered eight weeks after the implant placement (Figs. 7-8).

Follow-up visits were carried out at six months (Figs. 9-10), at first (Figs. 11-12), second (Figs. 13-14), third year (Figs. 15-16) & fourth year (Figs. 17-18). The patient also received a crown on tooth 45.

Treatment outcomes

The final outcome and the outstanding health of both hard and soft tissues at the 4-year follow-up showed that the treatment with this implant can be considered very reliable not only in a short-term but also in the mid-term. Moreover, the patient was pleased with the functional and aesthetic outcomes and had no mechanical nor biological complications.