Extraction with Immediate implant placement and bonded provisional restoration

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Extraction with Immediate implant

placement and bonded provisional restoration

Immediate implant placement

Dental implants can be placed in fresh sockets just after tooth extraction. These are called 'immediate' implants. 'Immediate-delayed' implants are those implants inserted after weeks up to about a couple of months to allow for soft tissue healing. 'Delayed' implants are those placed thereafter in partially or completely healed bone. The advantages of immediate implants are that treatment time can be shortened and that bone height might be maintained thus possibly improving the aesthetic results. The potential disadvantages are an increased risk of infection and failures of the immediately placed implants.

PROVISIONALIZATION AND TISSUE STABILITY

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

To maintain the tissue and underlying bony architecture and prevent it from collapsing after the extraction it is necessary to maintain the socket size and shape with an immediate prosthodontic technique. After extraction and insertion of the immediate implant, provisionalization can be achieved in several ways. One of the options is a prefabricated temporary crown; another is the fabrication of a provisionalize "Maryland FPD" from study models and a wax-up. It was decided to use a prefabricated "Maryland FPD" because of convenience and to ensure stabilization of the immediate implant.. After insertion of the temporary abutment, the prefabricated "Maryland FPD" was relined at the surgical site to maintain and support the tissue height. The temporary crown margin was polished and sealer was applied to make a smooth surface to prevent any irritation of surrounding tissue after cementation. Occlusal adjustments were made and the patient was told to avoid eating on the restoration to prevent any damage to the healing implant. The soft peri-implant tissue recedes approximately 0.6 to 1 mm. This recession generally occurs during the first month after surgery.

The patient was evaluated once a week for the first month; after three months he was scheduled for the final restoration. The temporary and aesthetic "Maryland FPD" were removed. An impression post was inserted into the implant and the final impression was taken with a custom tray. To fabricate the final restoration, the laboratory was instructed to fabricate a labially angled custom abutment with adequate space in the palatal portion for the PFM crown. The shade was selected to match the existing crown and

FINAL RESTORATION

After receiving the final restoration, the custom abutment was inserted into the implant and the PFM crown was tried in and cemented with 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 to replace missing natural teeth has been a well-accepted treatment option for many years. However, the healing time and sequence of surgical procedures involved in conventional implants, especially in the smile zone, has long been a major cause of patient resistance. Although further clinical research is needed, with the advances in knowledge and use of immediate implants with immediate temporization, patients have a new and better option for replacing missing teeth, as opposed to wearing removable appliances or waiting for the site to heal before receiving a new tooth. Immediate temporization with immdieate implants gives patients immediate satisfaction and a pleasing appearance.

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