Management of Unscheduled Anterior Tooth or Prosthesis Loss With Extraction and Immediate Implant Placement: A Clinical Report
Immediate treatment to manage an unscheduled patient esthetic crisis following an anterior tooth, crown, or prosthesis loss is important. The immediate management of the anterior esthetic crisis allows for definitive treatment at a separate appointment. Following initial esthetic management, the hopeless tooth or teeth can be replaced with definitive implant prosthetic treatment a short time later on an appointment basis. Most esthetic anterior tooth replacement is done with a delayed surgical implant protocol. This delay can result in loss of both soft and hard oral tissues during the healing period, necessitating soft tissue and bone augmentation procedures, including surgical bone expansion, guided tissue regeneration, bone block grafting procedures, or a combination. These losses often can be avoided at the time of tooth removal with immediate implant replacement. This article demonstrates a technique for management of a patient's unscheduled prosthesis loss with traditional dental treatment and then at a separate appointment, definitive treatment using immediate implant replacement with grafting for the extracted teeth. The article further describes the diagnostic and radiographic planning for immediate implant replacement with necessary bone expansion and grafting requirements, the fixed screw retained provisional restoration which stabilizes the implants following extractions and facilitates ease of removal for treatment, and lastly the final prosthodontic restoration of the missing teeth, restoring the esthetics of the affected area.Abstract
Figure 1 . Original patient appearance of cuspid retained fixed partial denture numbers 22–27. Figures 2 and 3. The proximity of roots numbers 27 and 28 endanger long-term success of implant replacement of number 27 if its position were replicated. The implant placement position needs to be moved mesially 2–3 mm for increased bone width between the implant and natural tooth. Figure 4. Preoperative panoramic radiograph gave only a 2-dimensional view. Figure 5. Computerized tomography scan gave 3-dimensional views as well as bone density measurements needed for bone expansion and spreading to enlarge the osteotomy site for implant placement.
(a and b) Parallel osteotomies were created with undersized twist drills and enlarged with osteotomes with minimal soft tissue reflection. (c and d) Implants in position for placement of ProTect abutments and transitional prosthesis.
Facial view of original prosthesis and ProTect abutments secured with acrylic resin.
(a) Implants placed. (b) Implants without TempBase assembly. (c) Implants with healing abutments to allow grafting with plasma-rich protein and PepGen P-15, prior to suturing and connection of TempBase assembly interim prosthesis. (d) Suturing complete.
Original proximity of tooth roots endangered success; implant position moved mesially 2–3 mm.
(a) ProTect assembly prosthesis facial view. (b) ProTect assembly prosthesis lingual view. (c and d) Immediate implant placement in extraction sites followed by placement of the prosthesis the day after surgery.
Figure 18 . Ten-days post-op surgery. Immediate implant placement in extraction sites followed by immediate placement of the prosthesis, 10 days after surgery. Figure 19. Three months after surgery, implants stabilized with etched bonding for healing period. No occlusal contact with opposing teeth in centric occlusion with minimal excursive contact for 3 months. Figure 20. Final impression for custom abutments 3 months after initial implant placement surgery. Open tray technique has similar accuracy to closed impression tray when transfer copings used. Figure 21. Final prosthesis day of insertion with very light occlusal contact with very firm biting pressure. Figures 22and 23. Completed implant reconstruction with radiograph at 3 years recall.
Contributor Notes
University of Missouri-Kansas City, Kansas City, Mo, Reconstructive & Implant Dental Center, Overland Park, Kan