Please activate JavaScript!
Please install Adobe Flash Player, click here for download

implants - international magazine of oral implantology

case report I The radiological control showed sufficient root fill- ing.Thecrownwasnotoptimallyplacedandtheintra- radicular post was of insufficient length and diameter (Fig.1).Ourinitialsuspicionofinflammationattheroot provednegativefollowingasecondX-ray. _Treatment focus The replacement of the intra-radicular post and a new crown did not seem to be sufficient treatment. Owing to the caries under the crown, the crown lengthening necessary to establish adequate biologi- cal width and the patient’s complaints regarding this region, any further effort to preserve this tooth made no sense to us. The aesthetic outcome was another reason to promote tooth extraction. Any further con- servativetherapywouldhaveresultedinaestheticde- ficiencies.Thepatientalsodesiredanefficientsolution that would put an end to the problems in this region. Furthermore,theadjacentteethonlyhadsmallfillings at the palatal surface and it would have been a pity to havetopreparethemforprosthodontics.Alsoforthis reason, the patient rejected prosthodontic treatment of the adjacent teeth.2-5,7 Our decision was to extract the tooth and imme- diately place an implant in order to support the soft tissue, influence bone remodelling and offer a tem- porary tooth replacement without a flipper.6,3,7,8,9,10,1 As the maxillary anterior region is an aesthetically sensitive region, we planned for an immediate im- plantation with simultaneous guided bone regener- ation (GBR).11,12 As for the prosthesis, we selected a biocompatible metal-ceramic crown for financial reasons. _Treatment plan Professionaltoothcleaningandpatientinstruction As a standard procedure, the patient received pro- fessional tooth cleaning before implantation in order to achieve optimal hygiene conditions. He also re- ceivedbehaviourandhygieneinstructionandwasen- couraged to follow a good oral hygiene routine. Extraction Thetoothextractionwasperformedascarefullyas possible and the socket was decontaminated with chlorhexidine solution and tetracycline for ten min- utes. Although mobile, the periodontal fibres were separated with a periotome. The tooth was mobilised withthesameinstrumentuntilanatraumaticpostex- traction was possible. Together with the tooth, we managedtoremovetheapicalcystwithoutneedingto scalethesocket.Carefulinspectionofthesocketwalls wasnecessarytopreventinflamedtissueaffectingthe GBR.Therewasalsonoperforationofthebuccalplate (Fig. 1).9,13 _Implantation and guided bone regeneration The implant we selected for this case was the inter- nal hex Laser-Lok implant (BioHorizons), which is ta- pered with microgrooves at the implant neck. Our aim was to achieve maximal bone adaptation to the crestal portion and soft-tissue adaptation to the implant neck.14,15,10,17-19 We used a periodontal probe to inspect thesocket.Thesocketwasrinsedagainwithchlorhexi- dinesolutionbeforeproceedingwiththeimplantation. Apartfromthefinaldrilling,thedrillsequencewasper- formed with water irrigation. The last drilling was per- formedat40rpm/minandmaximumtorqueinorderto decreasetheriskofridgeinjury. The gap width was 10.5 mm in the mesial-distal di- rection and 6 mm from the inner ridge in the oral- vestibular direction. The crestal thickness of the ridge wallswas0.5to1mm(Figs.2–4).6, 7, 9 Therefore,wede- cided to use a 4.6 mm implant with a length of 12 mm. Simultaneous to the implantation, we performed guided bone augmentation in order to fill the gap be- tweenimplantandridgeandtoinfluenceboneremod- ellingduringimplanthealing.Thegapbetweentheim- plantandbuccalboneplatewas1.4mm.Combinedwith the augmentation material (allograft using maxgraft, botiss) in this gap and on the buccal plate, we planned topreserveatleast2mmbuccallyafterboneremodel- ling. Onethirdoftheimplantwasinserted.Augmentation followed and then we inserted the implant com- I 25implants3_2012 Fig. 3a Fig. 3b Fig. 4a Fig. 4b Fig. 5bFig. 5a