A patient who is a 45-year-old woman and non-smoker has no medical record of interest. The patient complained of pain in the right second upper molar. She said that she felt intense pain while chewing. The pain was accentuated with occlusion and while chewing, making normal functioning impossible. The patient mentioned the absence of piece 16, which had been extracted 8 years previously.

Clinical examination showed a longitudinal fracture in the palatal root of molar tooth 17, which was confirmed by a radiographic examination (Fig. 1), which was removed during this appointment. Due to the absence of both molars, the patient expressed a desire to replace them with implants. She also worried about having metal in her mouth and insisted on an alternative material to titanium implants, as well as her intention to replace her molars with metal-free restorations. After 4 months of healing, we proposed as a treatment 2 white SKY (Bredent®) zirconia implants, (4.5 × 10 mm and 4.5 × 8 mm), with PEEK restorations and composite coating. The patient was informed about the intention to publish the results and agreed that the data from this study were public. The patient accepts the treatment and signs informed consent. The CIROM clinical committee has approved the oral surgery for Zirconia and PEEK implantation to the patient.

Initial exam

The edentulous crest showed an adequate amount of attached gingiva, thick enough to perform a flapless technique using a circular scalpel, allowing the integrity of the peri-implant structures to be maintained, while diminishing post-operative pain.

Surgical technique

For the flapless technique, we made two circular punch incisions in the gums, with a circular scalpel. The mucous plug was withdrawn with a periosteotome while maintaining the integrity of the gum around the incisions. We continued with the drilling indicated by the manufacturer, to insert two white SKY (Bredent®) zirconia implants of 10 mm length × 4.5 mm diameter in positions 17 and 16 (8 mm length × 4 mm diameter) (Fig. 2).

Healing period

Fifteen days after surgery, the appearance of the soft tissue was excellent, with no signs of inflammation in the mucosa. The patient mentioned the absence of bleeding and pain during the post-operation period. At the same time, we made a clinical and radiological evaluation. Three months after surgery, the stumps of the implants were carved to improve their parallelism with a special diamond drill (Kit Bredent®). Finally, we took impressions for the final restoration with polyether (Impregum, 3 M ESPE) without using retraction threads.

The final restorations were produced using CAD/CAM System Juvora® for the PEEK structure with composite coating (Anaxdent®). For cementation ionomer glass cement reinforced with resin was used (GC FujiCEM, GC Europe N.V.) (Figs. 3 and 4).

Tracking

A clinical and radiographic review carried out a year after the initial surgery showed the complete success of the procedure according to Albrektsson’s criteria and the natural aspect of the soft tissue around the restorations (Fig. 5).