Implants

I case report_ aesthetic placement 08 I implants1_2013 _Patient history A 38 year-old non-smoking woman, in good general health and with high aes- thetic demands, presented at our dental office with mobility of tooth #12 (Fig 1). After clinical and radiological examina- tion a horizontal fracture near CEJ (ce- ment enamel junction) was detected (Figs 1-4). Clinical examination showed class III mobility of the crown of #12. Aesthetic parameters were not altered. The buccal bone plate was not affected (Fig 2). The patient’s plaque control was adequate and no periodontal disease or periapical infection was detected (Fig 4). _Treatment planning It was not possible to prepare the tooth for restoration with a single crown due to the absence of ferrule. The short length of the root would lead to an un- satisfactory crown-root ratio in case of orthodontic extrusion, and crown lengthening was not indicated in this case because of aesthetic concerns. For these reasons tooth #12 was consid- ered hopeless. According to the options proposed by the ITI group in terms of implant placement timing after tooth extraction, the present situation would correspond to the “Type I” classification. Though the lip line is high, a medium- thick biotype, the lack of infection and a width of 1mm or more of the buccal bone wall (as revealed by computerised tomography) permits placing the implant immediately after tooth extraction. _Surgical procedure A very accurate root extraction was performed to keep the buccal plate in- tact (Fig 5). After verifying the integri- ty of the socket walls, the implant bed was prepared without flap elevation (Fig 6). We know that this approach - leaving the periostium attached to the bone - minimises the remodelling of the alveolar ridge. A Straumann® Bone Level Implant with SLActive® sur- face (Fig 7) was palatally positioned. The filling of the vestibular gap was ImmediateloadingwithaStraumann® BoneLevelImplantafterahorizontal toothfractureintheaestheticzone Author_Albert Barroso Fig. 1 Fig. 2 Fig. 3 Fig. 4