implants - the journal of oral implantology UK Edition

22 I I technique_ immediate placement implants1_2012 Immediate implant place- ment and temporisation in the aesthetic zone _The success of dental restorations can be mea- sured in terms of biological stability over time. With regards to dental implantology, the challenge is no longer one of integration, more long term aesthetic stability of the final restoration. Nowhere is this biological and aesthetic stability more important than in the aesthetic zone. Teeth and their roots have a supportive role to the alveolar bone in which they are retained. This bone in turn gives support to the gingival tissue overlying it, and the level of this bone directly affects the position of this gingival tissue.1 Following tooth loss, this sup- port is lost, and both the hard and soft tissue begin a process of remodelling. This process invariably results in the loss of bone, and an alteration in the gingival position. While it is possible to replace this support with the use of bone grafting or collagen plug techniques, this can involve a number of surgical procedures in order to achieve the final result. Original protocols in implantology required that implants be placed into healed edentulous ridges. Im- plants can, however, be placed at the time of tooth extraction.2 Such techniques can be used with si- multaneous augmentation to preserve ridge width, decreasing total treatment time. This paper and its case presentation, outline a technique which allows, in the right conditions, the replacement of the sup- port of a lost root, and consequently prevents major bone remodelling and subsequent alteration of soft tissue position. The following case is one of many completed, ranging from the single tooth to multiple units, all of which have a minimum of 12 months follow-up, and the results of which will be collectively published in the near future. The illustrated case in- volves a 63-year-old, retired female patient who was referred to the clinic timeously by her general dental practitioner following root fracture affecting the up- per left lateral incisor. Her chief complaint was one of poor aesthetics affecting this tooth (Fig 1). The condition of this tooth had declined gradually, followingplacementofacompositecrownthreeyears previously. The composite crown had been placed, re- tained by a temporary post, following failed root canal therapy during which an endodontic instrument was fractured in the tooth (Fig 2). The patient was in good health, a regular dental attendee with an adequate oral hygiene regime. A full dental assessment was undertaken to include as- sessment of immediate implant placement and tem- porisation in the aesthetic zone soft and hard tissue, remaining dentition, occlusion and parafunction, cur- Author_ Dr Philip J Friel Fig. 1 Fig. 2 Fig. 3