Use of Patient's Own Natural Teeth as Part of the Interim Prosthesis on Immediately Placed Single Implants in a Staged Surgical Approach: A Clinical Report
A technique is described where the tooth's natural crown is used as part of the interim implant supported prosthesis in clinical situations where a tooth with poor prognosis is extracted and an implant is placed immediately after tooth extraction. A preliminary impression is made before tooth extraction, and the exact tooth positioning is assessed in the laboratory as part of the treatment plan. An acrylic resin repositioning jig is fabricated that will guide the clinician in seating and orienting the crown intraorally after implant placement is completed. After the natural tooth is extracted and an implant is immediately placed via guided approach, the extracted natural crown is hollowed and placed on top of an interim abutment. The natural crown is positioned intraorally by using the acrylic resin repositioning jig. The crown is then internally relined and placed as part of the interim implant supported prosthesis. After osseointegration has been confirmed, a definitive prosthesis is placed.
Figure 1. (a) Intraoral frontal view of patient's preexisting condition. (b) Preoperative periapical radiograph of teeth #s 7 and 10. Figure 2. (a) Digital planning of implant #s 7 and 10 using Invivo 5 software. (b) Cone beam computerized tomography (CBCT) showing digital planning of implant #7. (c) CBCT showing digital planning of implant #10.
Figure 3. (a) Frontal view of maxillary cast, showing proclined tooth # 7. (b) Frontal view of tooth #7 after orthodontic arrangement. (c) Occlusal view of maxillary cast after orthodontic arrangement. (d) Acrylic resin orientation jig used for fabricating provisional crowns Figure 4. (a) Intraoral occlusal view of maxillary arch after extracting teeth #s 7 and 10. (b) Intraoral occlusal view of maxillary arch with surgical guide.
Figure 5. Intraoral occlusal view of maxillary arch showing particulate bone graft around implants #s 7 and 10. Figure 6. Intraoral occlusal view of maxillary arch with temporary cylinders on implants #s 7 and 10. Figure 7. (a) Extracted teeth # 7 and 10. (b) Facial surface of modified tooth # 7. (c) Palatal surface of modified tooth # 7. (d) Intraoral occlusal view of seated acrylic resin orientation jig. (e) Intraoral occlusal view showing blocked access hole for implant # 7 and modified natural tooth seated intraorally using acrylic resin orientation jig.
Figure 8. (a) Frontal and lingual view of finished natural tooth provisional (b) Intraoral occlusal view of natural teeth provisional in place on day of surgery. (c) Intraoral frontal view of natural teeth provisional in place on day of surgery. (d) Post-operative periapical radiograph of implants #s 7 and 10. Figure 9. Intraoral frontal view of natural teeth provisional after 3 months of healing. Figure 10. (a) Intraoral occlusal view of maxillary arch showing emergence profile around implants #s 7 and 10 and pontic area of #s 8 and 9. (b) Intraoral frontal view of maxillary arch showing emergence profile around implants #s 7 and 10 and pontic area of #s 8 and 9. (c) Intraoral frontal view of definitive prosthesis in place.
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