implants - international magazine of oral implantology

I research 10 I implants4_2012 Fig. 6_Clinical appearance (a) and radiograph (b) after 30 days. Figure 5b shows the dimensions of the abutment, on which a provisional (Fig. 5c) was fitted with a prefabri- catedacrylictooth. The follow-up radiograph and clinical follow-up demonstrated the good condition of the tissue, which facilitatedsubsequentrehabilitationprocedures(Figs.6 and7). _Discussion Theplacementofsingleimplantsimmediatelyafter extraction has been proven to be a treatment modality with predictable success (Lazzara 1989). However, cer- tainprecautionsshouldbetaken,suchastheposition- ingoftheimplant,thepresenceofbonetissuetoobtain theinitialimplantstabilityandthepresenceofalveolar bonewithoutgreatresorptionofthewalls,astheseare essential to the restoration of function and aesthetics (Tarnow&Eskow1995).Animportantconsiderationin theplacementofimplantsimmediatelyaftertoothex- traction is the behaviour of adjacent soft tissue during thehealingperiodbecause,accordingtoSchroppetal. 2003whostudiedthechangesintissue(boneandgin- giva)for12monthsaftertoothextraction,earlyimplant placement is favourable, thus increasing the preserva- tionofboneanatomyanddemonstratingtheeffective- nessofthetechnique. The3-Dpositionoftheimplantisimportantforthe development of the emergence profile of the tooth crown,especiallythelocationoftheimplantintheapi- cal direction. Therefore, the position of the IAJ influ- encesthelong-termoutcomes.Placementat1to3mm sub-crestallycanimprovetheaesthetics.Ahealingcap with an emergence profile could be used. The replace- mentoftheprostheticcomponentintheeventoftissue recession can help to maintain the texture and tone of the peri-implant mucosa, contributing also to the restorationofthemarginaltissuearchitecture(Bridges etal.2008). Inaclinicalandradiographicstudyindogs,inwhich implantswithreducedplatformwerepositionedatthe crest and 1.5 mm below the crest, Novaes et al. (2006) foundthattheimplantsshowedbetterresultssub-cre- stally,comparedwithimplantsplacedatthelevelofthe bone crest. Positioning the implants sub-crestally re- sulted in a location above the bone joining the implant and abutment and bone formation above the implant shoulder. Degidietal.(2011)reportedintheirretrospectivehis- tological study on nine patients whose implants were placedatdifferentlevelswithrespecttothebonecrest. In the sub-crestal implants, pre-existing bone forma- tionwasfoundontheimplantshoulderandnobonere- sorptionwasfoundwhentheimplanthadbeeninserted toadepthof3mm,butboneformationcontactingthe surfaceoftheabutment.Thus,placingtheimplantata sub-crestal level seems to be a good alternative for achieving an aesthetic result; however, further studies arenecessary. _Conclusion The placement of an implant immediately after ex- tractionandplacementoftheprovisional,inmostcases, isasuitablealternativebecauseithelpstopreservebone structure and gingiva. Additionally, it provides the pa- tient with immediate psychological benefit, aestheti- cally and functionally. With the new design concepts andrelationbetweentheabutmentandtheimplantre- gardingposition,implantssuchasMorsetaperimplants can help maintain a larger amount of peri-implant tis- sue,thusimprovingtheaestheticcondition._ Prof Sergio Alexandre Gehrke Rua Bozano,571 Santa Maria – RS 97015-001 Brazil Tel.:+55 55 3222 7253 sergio.gehrke@hotmail.com _contact implants Fig. 6a Fig. 6b Fig. 6c