implants - the journal of oral implantology UK Edition

24 I I technique_ immediate placement implants1_2012 Given the implant is placed directly into the extraction socket, and that the adequately supportive temporary crown provides an excellent crestal gingival seal, no flap is required and consequently, no sutures are used in this procedure. Standard post-operative protocols are followed. As a result of this flapless approach, the trauma of surgery is lessened, and review one week post-surgery shows an excellent recovery (Fig 8), with very little sign of any trauma, swelling or alteration of the surrounding gingival tissue, which largely re- mains unchanged. After a five-to-six month healing period, during which regular review is undertaken, the temporary crown is removed using a crown remover. The temporary abutment is removed and the socket irrigated. A standard open tray impression technique is used to record the position of the implant, and the temporary abutment and crown replaced. The sub- sequently produced model is used to construct an abutment and crown, replicating the exact support given by the temporary set up. The case is completed by final abutment placement and torque to 35Ncm. Following trial fit, and approval of the definitive res- toration, the occlusion is checked and adjusted as re- quired . The Zirconia crown is cemented using a resin cement, with care being taken to minimally load the cement and remove any excess prior to and after cure. Occlusion is again assessed and adjusted as required. The success of the restoration is evident immediately after cementation (Fig 9); at three-month (Fig 10); six- month (Fig 11) and 18 month review (Fig 12a & b). In order to successfully perform the procedure outlined above, timing is essential, particularly in the case of the root fractured tooth. In these cases, if such treat- ment is not initiated in good time, the area can be- come infected with corresponding sinus formation and inevitable loss of the buccal plate of bone. This would entail reassessment and treatment using a multi-staged, delayed placement regime. In order to perform flapless surgery, the operator must have suit- able experience, and be competent in the procedure. Added to this, as with any surgery, a full knowledge and appreciation of the anatomy surrounding the surgical site is essential to ensure a successful out- come. It is sometimes necessary to carry out further spe- cial tests or procedures during the planning stages, to ascertain further information prior to commence- ment of treatment. These may include CT scanning or ridge mapping of the proposed surgical site. Follow- ing atraumatic tooth extraction and socket assess- ment it may, occasionally, not be possible to proceed with immediate implant placement for a number of reasons. In such cases proper planning is essential to ensure that an alternative treatment option may be undertaken. While flapless surgery incurs decreased trauma and faster healing, during any flapless pro- cedure, it must be remembered that the operator can, at any time, raise a flap, if at all concerned with regards to surgical progress. Biological stability has been maintained from removal of the damaged root right through to cementation of the definitive resto- ration. By respecting and understanding the natural tissues in this way, predictably excellent results can be achieved time after time. The clinical photographs and case discussion are included with the expressed permission of the patient involved. All of the laboratory stages for the case were completed by Lincoln Ceramics, Glasgow_ _References 1.GargiuloetalJ.Periodontol,1961,31:261–267. 2.LazzaraRJ.Immediateimplantplacementintioextraction sites: surgical and restorative advantages. Int J Periodont RestDent1989;9:332–343. 3. Quayle A. Atraumatic removal of teeth and root frag- mentsinDentalImplantology.IntJOralMaxillofacImplants 1990;5:293–296. 4. Botticelli et al. The jumping distance revisited : An ex- perimental study in the dog. Clin Oral Implants Res 2003;14(1):35–42. FirstpublishedinScottishDentistMarch-April2008._ DrPhilipJ.Friel,PhilipFrielAdvancedDentistry,170Hyndland Road,G129HZGlasgow,GreatBritain implants Dr Philip J. Friel Philip Friel Advanced Dentistry 170 Hyndland Road G12 9HZ Glasgow, Great Britain _contact Fig.10 Fig.11 Fig.12a Fig.12b