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Clinical cases

Dr Thomas


Mondelange - France

Mr Philippe


Cavelius dental lab

Bimaxillary flapless rehabilitation, with no soft tissue with Axiom® TL (Tissue Level) implants

A 61-year-old patient in good health, but presenting with terminal periodontitis. She wishes to resume quickly a functional and aesthetic oral quality. A first pre-implant surgical phase involved the maxillary (sinus lift) to allow the placement of Axiom® TL (Tissue Level) implants in the posterior area. In the mandible, the edentulous posterior regions make the placement of implants impossible behind the mental foramina due to advanced vertical and lateral bone resorption. 5 Axiom® TL (Tissue Level) implants will be placed. The ones in the most posterior region will be sharply angulated to allow the passage of the mental nerve emerging as distally as possible.

1 – Initial situation of the mandible.

2 – Axiom® TL (Tissue Level) implant neck Placed at least 1 mm in subgingival tissue.

3 – The sleeves are cut so as not to extend beyond the occlusal plane to allow the impression in occlusion.

4 – Maxillary surgery is performed entirely flapless, with the assistance of a surgical guide. Surgical consequences are minimal for the patient, both in terms of pain and of peri-implant tissue integrity as can be seen in this photo, showing the healing screws a few hours after the end of surgery.

5 – The temporary prosthesis is produced using the temporary
abutments immersed in resin. No dental extension is planned at this stage on this temporary prosthesis. In order to facilitate the placement of the prosthesis on the implant plates, which are flat, two guiding locks are inserted from one to the other side on the prosthesis.

6 – These locks, both regular and guiding, are included in the inLink® integrated locking system and allow prosthesis manipulation without the risk of losing the screws. The system is tightened with a simple ¾ turn of the key. This operation becomes very quick and easy thanks to this new lock system.

7 – 8 – A few months later, after the healing phase, the temporary prosthesis is taken out and the impression transfers are put in place.

8 – There are two plate diameters: 4.8 mm (blue) for the posterior regions and 4 mm (pink) for the regions with strong aesthetic impact.

9 – Although tricky to use, the plaster impressionremains for us the best to reproduce with accuracy the implant position.

10 – The plaster keys are tested. If one is cracked, a new impression should be taken to ensure bridge passivity.

11 – CAD concept image of the maxillary frame Simeda®: the screw channels in yellow and the implant axes in blue show the angulation of the screw channels.

12 – Once the impressions are scanned by the prosthetics laboratory, a digital concept of the prosthetic infrastructure is obtained and the files are sent to Simeda®. The two elements have been produced with high precision by Simeda®. The infrastructures are fitted in the mouth and the intermaxillary ratio is again recorded before the final ceramic assembly.

13 – Occlusion must be adjusted accurately on the biscuit before its last firing and to allow the prosthetist to customise the shade with the patient.

14 – Final prosthesis in the mouth: Axiom® TL (Tissue Level) implants enable perfect integration with bone and gum tissue.

15 – Follow-up panoramic X-ray. Axiom® TL (Tissue Level) implants enable perfect integration with bone and gum tissue.

16 – The emergence of the access channels could be optimised upstream, as axis adjustment of the prosthesis can be expected. The channels are further closed with composite.

17 – Final appearance of the prosthesis which appears natural with no soft tissue.

18 – For the patient, the aesthetic and functional challenge has been overcome.


Axiom® TL (Tissue Level) implants placed with the flapless technique have allowed the preservation of the soft tissues and quick healing. Thanks to access channels, angulated at 25°, the screw channels have been placed perfectly on the prosthesis. “I was attracted by the convenience of a screw-less prosthesis. The aesthetic result obtained with these two prostheses with no soft tissue is thoroughly satisfactory for the patient.”