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Hahn™ Tapered Implants: A Versatile Foundation for the BruxZir® Full-Arch Implant Prosthesis

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by Jack A. Hahn, DDS

Full-arch implant restorations offer substantial advantages over traditional dentures, including increased stability, function and preservation of the underlying bone.1,2 As awareness of these benefits increases, the number of fully edentulous patients opting for implant treatment continues to rise. Additionally, advancements in prosthetics, implant design and CAD/CAM technology have made it so implants can be predictably placed in patients with varying degrees of dental health. This expands the population eligible to receive such treatment and enables practitioners to offer it with the confidence that both implants and prosthesis will stand the test of time. Indeed, the emergence of the BruxZir® Full-Arch Implant Prosthesis means that we no longer have to worry about the wear and breakage that can afflict fixed acrylic appliances.

Although all full-arch implant restorations provide superior function and quality of life compared to conventional dentures, the fixed implant-supported prosthesis has been shown to provide higher levels of patient satisfaction than removable overdentures.3,4 Because of its unmatched durability and excellent esthetics, monolithic zirconia is an ideal choice for fixed full-arch indications. Screw-retained acrylic hybrid dentures are vulnerable to wear and tear over time, from teeth separating from the body of the prosthesis to outright fracture. For practitioners who stand by their work, this can become costly as repair expenses add up over time, to say nothing of the frustration caused to the patient and potential harm caused to the reputation of the dental practice. The BruxZir Full-Arch Implant Prosthesis has a monolithic construction that avoids such damage and can typically be provided at a similar cost to that of a traditional acrylic hybrid denture.

When treatment planning such a restoration, it is necessary to select an implant system that can be placed in areas of the edentulous ridge where there is a limited amount of space, as many denture wearers have experienced substantial bone loss by the time they upgrade to an implant restoration. Further, an implant’s thread design should engage the bone and afford maximum control to the clinician during placement, enabling positioning that supports an esthetic prosthetic outcome. This is especially important when treating patients who present with hopeless, non-restorable dentition, as the immediate extraction and implantation procedure that is commonly indicated in such cases requires an implant that maintains the correct lingual position during insertion.

The Hahn™ Tapered Implant (Glidewell Direct; Irvine, Calif.) has been designed with these precise considerations in mind, making it an optimal choice for fixed full-arch indications. A review of its design features, along with some case examples, serves to illustrate how this new implant system establishes a predictable foundation for the most durable restoration available to the fully edentulous patient.

Precise Control During Implant Placement

With a design that maximizes clinician control during surgical placement, the Hahn Tapered Implant excels in establishing the position needed for a predictable, esthetic full-arch restoration. Its sharp, angled threads help maintain the proper distance from the buccal aspect as the implant is threaded into place. Because the threads fully engage the lingual wall and the tapered shape allows for flexibility in angulation, the implant is more easily positioned in a manner that avoids the occurrence of screw access holes exiting toward the buccal or labial surface of the planned prosthesis (Figs. 1a–1d).

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Figures 1a–1d: As illustrated by these two cases, Hahn Tapered Implants can be positioned with minimal difficulty in a manner that keeps the screw access holes situated within the lingual or occlusal surfaces of the full-arch prosthesis.

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Figures 1a–1d: As illustrated by these two cases, Hahn Tapered Implants can be positioned with minimal difficulty in a manner that keeps the screw access holes situated within the lingual or occlusal surfaces of the full-arch prosthesis.

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Figures 1a–1d: As illustrated by these two cases, Hahn Tapered Implants can be positioned with minimal difficulty in a manner that keeps the screw access holes situated within the lingual or occlusal surfaces of the full-arch prosthesis.

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Figures 1a–1d: As illustrated by these two cases, Hahn Tapered Implants can be positioned with minimal difficulty in a manner that keeps the screw access holes situated within the lingual or occlusal surfaces of the full-arch prosthesis.

With a design that maximizes clinician control during surgical placement, the Hahn Tapered Implant excels in establishing the position needed for a predictable, esthetic full-arch restoration.

This thread design is especially helpful in immediate extraction and implantation cases, where keeping the implant in the correct buccal-lingual position is crucial in order to avoid contact with the facial plate (Fig. 2). Patients who present with hopeless dentition are constituting an increasingly large portion of full-arch implant restorations, so this design feature is essential. Practitioners will find that placing an implant that stays firmly in the direction it is guided and avoids shifting toward the facial greatly simplifies placement into fresh extraction sockets.

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Figure 2: Note how in this immediate extraction and implantation case, the Hahn Tapered Implant effectively engages the palatal wall of the socket sites, establishing the precise position needed to preserve the bone and support an esthetic restoration.

Maximum Primary Stability

The Hahn Tapered Implant provides an extremely stable foundation for fixed full-arch implant restorations in all bone qualities. The pronounced thread pattern maximizes contact with the bone of the implant site, resulting in excellent primary stability (Figs. 3a, 3b). The tapered shape and wider prosthetic platform of the implant further enhances the initial stability of the implant.5 These design features offer more confidence in the immediate loading of a fixed provisional appliance (Figs. 4a, 4b).

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Figures 3a, 3b: Note the favorable integration of the Hahn Tapered Implants in this patient’s maxilla immediately following teeth extraction and implantation.

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Figures 3a, 3b: Note the favorable integration of the Hahn Tapered Implants in this patient’s maxilla immediately following teeth extraction and implantation.

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Figures 4a, 4b: Radiograph exhibits placement of the implants within the remaining mandibular and maxillary bone following teeth extraction, establishing the primary stability needed for immediate provisionalization with modified dentures. Note the modified temporary cylinders attaching the lower provisional denture to the implants and the multi-unit abutments on the upper implants.

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Figures 4a, 4b: Radiograph exhibits placement of the implants within the remaining mandibular and maxillary bone following teeth extraction, establishing the primary stability needed for immediate provisionalization with modified dentures. Note the modified temporary cylinders attaching the lower provisional denture to the implants and the multi-unit abutments on the upper implants.

The increased surface area of the sharp buttress threads also allows for flexibility in surgical protocols, which can be adjusted in response to bone quality. For example, when placing the implant within soft bone, in many cases a 3.5 mm surgical drill can be used to prepare an osteotomy for a 5.0-mm-diameter implant, which can be self-tapped into the site, compacting the bone and helping to facilitate single-stage surgery. Whichever protocol is followed, the implant system is designed to include fewer drilling steps, with diameter- and depth-specific drills that increase efficiency. The implant’s self-tapping grooves and thread pitch contribute to swift insertion.

Limited Anatomical Space

Another key advantage of the Hahn Tapered Implant System is its degree of taper and wide range of lengths and diameters, which allow for more flexibility in areas of limited bone. This eases implantation in regions where there are undercuts, bone volume constraints, or critical anatomical structures. It also helps the practitioner adjust the angulation to establish a favorable position for the eventual prosthesis. In combination with 17- or 30-degree multi-unit abutments, this can produce excellent results for patients who otherwise would not be indicated for such treatment (Figs. 5a–5c).

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Figures 5a–5c: In this immediate extraction and implantation case, the Hahn Tapered Implants were effectively positioned within a maximum amount of bone, and the angulation of the implants corrected for by multi-unit abutments, establishing a level restorative platform for the BruxZir Full-Arch Implant Prosthesis.

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Figures 5a–5c: In this immediate extraction and implantation case, the Hahn Tapered Implants were effectively positioned within a maximum amount of bone, and the angulation of the implants corrected for by multi-unit abutments, establishing a level restorative platform for the BruxZir Full-Arch Implant Prosthesis.

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Figures 5a–5c: In this immediate extraction and implantation case, the Hahn Tapered Implants were effectively positioned within a maximum amount of bone, and the angulation of the implants corrected for by multi-unit abutments, establishing a level restorative platform for the BruxZir Full-Arch Implant Prosthesis.

This ability to angulate is vital for All-on-4 cases, which call for tilting of the posterior-most implants in order to avoid critical patient anatomy and accommodate limited bone quantity (Figs. 6a–6d). Additionally, many potential All-on-4 cases are immediate extraction replacements of hopeless teeth, and the Hahn Tapered Implant is best-suited for such scenarios, where primary stability is imperative.

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Figures 6a–6d: This patient’s mandible, which had experienced severe posterior atrophy after years spent wearing a conventional denture, has been restored with a BruxZir Full-Arch Implant Prosthesis, with the Hahn Tapered Implants accommodating the constricted areas of the edentulous arch.

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Figures 6a–6d: This patient’s mandible, which had experienced severe posterior atrophy after years spent wearing a conventional denture, has been restored with a BruxZir Full-Arch Implant Prosthesis, with the Hahn Tapered Implants accommodating the constricted areas of the edentulous arch.

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Figures 6a–6d: This patient’s mandible, which had experienced severe posterior atrophy after years spent wearing a conventional denture, has been restored with a BruxZir Full-Arch Implant Prosthesis, with the Hahn Tapered Implants accommodating the constricted areas of the edentulous arch.

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Figures 6a–6d: This patient’s mandible, which had experienced severe posterior atrophy after years spent wearing a conventional denture, has been restored with a BruxZir Full-Arch Implant Prosthesis, with the Hahn Tapered Implants accommodating the constricted areas of the edentulous arch.

Equally important is the tapered design of the Hahn Tapered Implant, which is essential for cases in which All-on-4 treatment and similar protocols are indicated, as it allows for placement of an implant with a larger diameter in anatomically constricted areas. For the edentulous maxilla, the placement of six implants or more can be advantageous when possible in order to account for bone quality and to better distribute the impact of occlusal forces and substantial off-axis loading to which fixed full-arch restorations are subject. While finding the necessary bone volume to accommodate six implants in the maxilla can be a challenge, the ability of the Hahn Tapered Implant to fit within tight anatomical spaces simplifies such an undertaking (Figs. 7a–7c).

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Figures 7a–7c: The versatility of the Hahn Tapered Implant System allowed for the placement of seven implants in this patient’s edentulous maxilla, despite the space limitations present along the arch. In tandem with the monolithic zirconia full-arch implant prosthesis, the osseointegrated implants offer an excellent long-term prognosis.

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Figures 7a–7c: The versatility of the Hahn Tapered Implant System allowed for the placement of seven implants in this patient’s edentulous maxilla, despite the space limitations present along the arch. In tandem with the monolithic zirconia full-arch implant prosthesis, the osseointegrated implants offer an excellent long-term prognosis.

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Figures 7a–7c: The versatility of the Hahn Tapered Implant System allowed for the placement of seven implants in this patient’s edentulous maxilla, despite the space limitations present along the arch. In tandem with the monolithic zirconia full-arch implant prosthesis, the osseointegrated implants offer an excellent long-term prognosis.

Conclusion

The Hahn Tapered Implant is a versatile, efficient solution for a wide variety of indications, including monolithic zirconia full-arch restorations. By simplifying buccal-lingual positioning, maximizing primary stability, and easing placement into limited anatomical spaces, the implant predictably establishes the restorative platform needed for the BruxZir Full-Arch Implant Prosthesis. Monolithic zirconia has established a new standard in prosthetic durability for full-arch restorations, and the Hahn Tapered Implant affords practitioners the clinical flexibility needed to offer this life-changing treatment option to as many patients as possible.

Note: Clinical dentistry and images in Figures 4a and 4b courtesy of Paresh B. Patel, DDS.

References

  1. Harris D, Höfer S, O’Boyle CA, Sheridan S, Marley J, Benington IC, Clifford T, Houston F, O’Connell B. A comparison of implant-retained mandibular overdentures and conventional dentures on quality of life in edentulous patients: a randomized, prospective, within-subject controlled clinical trial. Clin Oral Implants Res. 2013 Jan;24(1):96-103.
  2. Kordatzis K, Wright PS, Meijer HJ. Posterior mandibular residual ridge resorption in patients with conventional dentures and implant overdentures. Int J Oral Maxillofac Implants. 2003 May-Jun;18(3):447-52.
  3. Preciado A, Del Río J, Lynch CD, Castillo-Oyagüe R. Impact of various screwed implant prostheses on oral health-related quality of life as measured with the QoLIP-10 and OHIP-14 scales: a cross-sectional study. J Dent. 2013 Dec;41(12):1196-207.
  4. Brennan M, Houston F, O’Sullivan M, O’Connell B. Patient satisfaction and oral health-related quality of life outcomes of implant overdentures and fixed complete dentures. Int J Oral Maxillofac Implants. 2010 Jul-Aug;25(4):791-800.
  5. Maiorana C, Farronato D, Pieroni S, Cicciu M, Andreoni D, Santoro F. A Four-Year Survival Rate Multicenter Prospective Clinical Study on 377 Implants: Correlations Between Implant Insertion Torque, Diameter, and Bone Quality. J Oral Implantol. 2015 Jun;41(3):e60-5.
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