Extraction, Immediate LOAD implant
with a
bonded "Maryland" FPD crown

Dental implants can be placed into fresh extraction sockets immediately after tooth removal. These are called "immediate implants". Delayed implants are those placed into partially or completely healed bone. One of the main advantages of an "immediately implant" is the "loading" of it.  If loading of the implant is achievable with an esthetic provisional crown(s), a removable plastic partial denture for tooth or teeth replacement is avoided.  This loading technique shortens treatment time and preserves soft tissue contours and bone height, providing an aesthetic outcome. The disadvantage of immediate loading, although small, is an increased risk of lack of osseointegration of the immediately Load implant.
 

PROVISIONALIZATION AND TISSUE STABILITY

Gingival tissues shape is based on tissue surrounding nature teeth.  Preserving osseous architecture is the key to predicting the eventual gingival tissue position and natural aesthetics.  To maintain tissue and underlying bony architecture and prevent bone loss after extraction, it is necessary to maintain socket size and shape with an immediate prosthodontic replacement.  After tooth removal and insertion of an immediate implant, provisionalization can be achieved in one of several ways. A prefabricated provisional crown is attached directly to the implant.  Another technique is the fabrication of a provisional "Maryland Bridge" to ensure stabilization of the immediate load implant. After insertion of a temporary abutment, the prefabricated "Maryland FPD" can be relined at the surgical site to maintain and support the soft tissue height.  Occlusal adjustments are then made and the patient is advised to avoid eating on the restoration to allow uneventful healing. 

The following patient was evaluated once a week for the first month after treatment.  After three months the patient was scheduled for final restoration.  The provisional aesthetic "Maryland Bridge" was removed. An impression post was inserted into the implant and the final impression was taken with an open tray technique. To fabricate the final restoration, the laboratory used an angled custom abutment with adequate space for the PFM crown.  The shade was selected to match the existing teeth.

After receiving the final restoration, the custom abutment was inserted into the implant and the PFM crown
was luted to it with resin modified glass-ionomer cement.

Because gingival tissue possesses biological memory, preserving osseous architecture is the key to predicting the eventual gingival tissue position

CONCLUSION

The use of dental implants for immediate replacement of a missing tooth or teeth has become a well accepted treatment option. The healing time of surgical procedures involved with traditional dental implants in the past, "in the smile zone", had been a cause of patient concern.  Clinical research is onging, but with the knowledge and techniques now available, the use of immediate implants with provisional crown(s) in the aesthetic zone is very acceptable.  Patients now have a better option for replacing a missing tooth or teeth at the time of surgery, without need for  a removable appliances and waiting for the socket(s) to heal.   The immediate load implant gives patients greater satisfaction with aesthetic outcome.

Immediate Implant Placement

Traumatic Injury to Lateral Incisor

Radiograph of Fractured Lateral Incisor   

Panoramic Radiograph of Fractured Lateral Incisor

Extraction Socket                                                 Extracted Tooth

                                                                Implant Placed                                            Implant Socket Graft            

           Post-Op Radiograph FPD in Place              

Panoramic Radiograph with Provisional Restoration in Place

Provisional Restoration Day of Surgery

 Provisional Restoration Day of Surgery    3 Days Post-Op Provisional Restoration

3 Months Post-Op Provisional Removed

Custom Abutment

Final Restoration

Final Restoration

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