One stage implantation with immediate non-functional restoration

Author:

Alexander Kobyakov

Oral and maxillofacial surgeon

Place of work: Regional Hospital named N.I. Pirogov, Department of Maxillofacial Surgery

Experience in implantation : 4 years

Denturist: Ivan Gontar

One stage implantation with immediate non-functional restoration

Considerable defect of dental arch could arise after loss of front teeth. That is a real challenge both for a patient and a dentist in choosing the type of dental rehabilitation method. In some cases two stage implantation is not appropriate and immediate implantation is the only way.

The one-step implantation with immediate loading was invented in the early 30th by Dr. Alvin Strock, maxillofacial surgeon from Boston, who successfully placed orthopedic screw in alveolar socket. Such implant system successfully worked for 18 years. In addition, in the sixties this method of implantation has been replaced by two-stage implantation. However, with developed technologies of implants manufacturing and successful studies in osseointegration, in the middle of 80^th, one-step implantation with immediate loading become popular again. (Schiroli G : Immediate tooth extraction, placement of a Tapered Screw- Vent implant, and provisionalization in the esthetic zone: a case report, Implant Dent 12 ( 2 ): 123 - 131 , 2003.)

(Rosenlicht JL : Immediate implant placement and immediate provisionalization: Steps for integration. Implantology 2003, Mahwah, NJ, 2003, Montage Media Corp , pp 46-52.)

Fig. 1. Single-stage implantation with orthopedic screws, followed by the crown restoration made from patient's tooth.

Fig. 2. Left  - result after 8 years and on the right - result after 9 years of orthopedic bone screws implantation in alveolar socket (From Rosenlicht JL, Ward J, Krauser JT: Impressions at surgical placement and provisionalization of implants. In Fonseca RJ, et al, editors: Oral and maxillofacial surgery, vol 1, St Louis, 2009, Elsevier)

Case report

A patient Z., 27 years old, complained on mobility in coronal part of 11 tooth ,which was the result of excessive loading on the tooth during meal.

Previously this tooth was treated by endodontist.

OBJECTIVE: 11 tooth examination shows its mobility in the coronal part in vestibular oral direction, as well as swelling and discoloration of gingival papilla between 11 and 21 teeth.

Computer thermogram showed a violation of 11 tooth root integrity between middle and lower third of fracture line and displaced of root fragments.

The diagnosis: fracture of 11 tooth root with fragments displacement.

Taking into account the patient's age and profession, it was decided to remove 11 teeth and apply one-step implantation and immediate non-functional restoration.

Surgery progress: under local anesthesia with Ubistezin forte, a dentist made atraumatic removal of 11 tooth with the preservation of vestibular wall. The dentist made operative exploration of alveolar socket, curettage and rinsing with antiseptic solution. He also made palatal initiating osteotomy of socket wall with round bur and created a platform for more stable position of pilot drill. Then, the dentist made initiating osteotomy with pilot drill and set implant position. According to Bio3 protocols, he made consistent osteotomy of the palatal wall and formed implant bed. Bio3 Progressive 3,8 / 13 implant was placed and fixed at 3-4 mm above the enamel-cement border of adjacent teeth with 35-40 N / sm2. The space between vestibular wall and the implant was filled with Bio3 Beta Bone synthetic graft material. In order to prevent aesthetic defects, the dentist made FTA from hard palate to gingival margin of 11 tooth. Orthopedist used straight  abutment for 11 tooth restoration, which was screwed with implant (10N / sm2). Temporary restoration was made on the basis of occlusion in order to prevent loading on the implant and surrounding tissues.

Post-surgery, antibiotic and anti-inflammatory therapy was prescribed in accordance with international recommendations.

On the 10th day after surgery, the dentist determined normal process of wound healing and normal color of the gingival papilla between 11 and 12 teeth. In addition, it was decided to make extra fixation of abutment to 15N / cm2 and to cut edge correction of restoration.

Fig. 3. Before implantation: well-defined swelling and discoloration of the gingival papilla between 11 and 12 teeth.

Figure 4. During tooth extraction. Root fracture line.

Fig. 5. Formation of a space for pilot drill.

Fig. 6. The pilot osteotomy.

Fig. 7. Checking the position for the implant.

Fig. 8. The final osteotomy was performed without cooling 50-100 vol. / min.

Fig. 9. After implant placement.

Fig. 10. Process of implant placing with torque wrench.

Fig. 11. 35H / sm2 force.

Fig. 12. Taking FTA from hard palate.

Fig. 13. FTA fitting to its future position.

Fig. 14. Abutment fixed on the implant.

Fig. 15. Contouring of temporary restoration in hands.

Fig.16. Final grinding and polishing of temporary crown in the mouth.

Fig. 17. After implantation in the day of surgery.

Fig. 18. After10 days with extra superstructure fixation and crown contours correction to 15N / sm2.

Fig. 19. Radiography of 11 tooth before and after implantation.

Fig. 20. Two months later.