Tittle:

Immediate Implant Placement and Provisionalisation in the Esthetic Zone: A Case Report 

 

Objective:

To demonstrate: 

1. A phased surgical and prosthodontic method for immediate implant placement in the esthetic zone.
2. A digital approach to ensure precise implant positioning in the esthetic zone.
3. The use of a SCTG at the time of immediate implant placement.
4. An immediate loading technique to facilitate proper soft tissue support.

 

Cas presentation

Fig. 1: A 42-year-old Hispanic male presented with a horizontal root fracture at tooth #10.

Fig. 2: A CBCT scan confirmed the degree of the horizontal fracture, aiding in the upcoming implant planning. A 3D implant planning software was utilized for surgical guide preparation.

Fig. 3: Extraction of tooth #10 and immediate implant placement (2.9x12mm) followed by SCTG and bone graft. The extracted tooth was used for the immediate loading. 

Fig. 4: Intraoral scan was taken for the fabrication of a customized abutment. A lab custom abutment pattern was fabricated for try-in. 

 

Discussion:

• Hard and soft tissue remodeling will occur following the extraction of teeth. This can lead to esthetic issues: Lack of buccal bone and thin soft tissue surrounding the implant causing irregular gingival margins.
• Performing a SCTG at time of implant placement enhances soft tissue thickness. 
• When fabricating the final restoration, challenges may arise if the prefabricated abutment's height is short. A custom abutment retaining a screw-retained crown instead of pre-fabricated titanium base was used for improved emergence profile and retention/resistance form.

Conclusions:

• Immediate implant placement in the esthetic zone can be challenging. Surgical and prosthetic measures are necessary to predictably preserve both hard and soft tissues. 
• Using guided implant surgery, combined with a SCTG ensures satisfactory soft tissue thickness around the implant site. 
• Creating a properly contoured provisional aids in the optimal healing of soft tissues surrounding the implant. If pre-fabricated abutments are not suitable, a customized abutment can be selected for the final screw-retained crown.