Immediate Implant and Customized Healing Abutment Promotes Tissues Regeneration: A 5-Year Clinical Report
Significant alveolar bone resorption follows tooth extraction. Immediate implant placement alone is not sufficient to prevent this phenomenon. The present study aims at reporting the clinical and radiologic outcome of an immediate implant with a custom healing abutment. In this clinical case, a fractured upper first premolar was replaced by an immediate implant and a customized healing abutment designed on the perimeter of the extractive alveolus. After 3 months, the implant was restored. The facial and interdental soft tissue was maintained with appreciable success after 5 years. The pre-and 5-year post-treatment computerized tomography scans showed bone regeneration of the buccal plate. Use of an interim customized healing abutment helps prevent hard- and soft-tissue collapse and promotes bone regeneration. This technique is straightforward and may represent a smart preservation strategy when there is no indication for adjunctive hard or soft tissue grafting. Given the limited nature of this case report, further studies are needed to confirm the present findings.
Intra-oral digital photographic documentation of the clinical appearance of the first premolar with evident fracture, soft tissues suffering, and dyscromia.
Sagittal section of the CT scans showing the tooth fracture and the presence of sufficient apical bone to place an immediate implant with primary stability.
3D reconstruction of the maxilla.
The implant is in place, slightly palatal, and juxta-crestal. The gap is left ungrafted, but, at the buccal and at the palatal sides, two rectangular pieces of collagen membrane were pinned between the residual alveolus and the implant.
A castable abutment was screwed to the implant and flowable resin was applied around the abutment to create a rigid cap adjoining the edges of the alveolus.
Four months later, soft tissue appeared pinky and thick with an abundant profile, optimal for prosthetic finalization.
The soft tissue tunnel has been perfectly conditioned by the custom abutment.
A final screw retained zirconia restoration was inserted.
The intraoral view 5 years after implant placement showed optimal esthetics and stability of the surrounding tissues with overall mimesis and color integration.
A further 3D scan was performed and it was possible to appreciate the bone regeneration achieved.
Contributor Notes