Indication 4 Case 6

Single tooth gap maxilla


Dentist:
Dr. Anton Friedmann, Prezmek Jawor
Dept. of Periodontology and Synoptic Dentistry
Dental School, Charité - Medicine Faculty Humboldt University
Berlin, Germany

Dental Technician:
Jörg Leonhardt, Labor LeoDent, Berlin, Germany
 
Introduction:
The immediate replacement of a tooth by an endosseous implant combined with the immediate loading of the implant may represent a striking issue. In the aestethic region the support of the buccal bone lamina and the preservation of the gingival line are prerequisites for the success of the restoration. In such a case, if the dentition is free of any other signs of inflammatory disease, the concept of immediate implantation with the immediate loading appear suitable.

	1 A male patient 28 years old with periapical lesion of the tooth 11. The supposed reason was insufficient endodontical treatment or root fracture of mentioned tooth. Clinically the patient report recurrent abscesses of this region, and no improvement after root canal re-treatment.

	2 The extraction of 11 was unavoidable. Because of the condition of the neighbor teeth the bridge could be insufficient solution, so the decision we made was immediate implantation of the ITI TE implant, with immediate loading of the implant (aesthetic needs). To extract the tooth in a minimal invasive way and to save the buccal bone lamina, the desmotom was used as the extraction instrument.

	3 With the help of this tool the periodontal ligament was carefully separated, and the extraction of the tooth took place. The extraction socket after removal with (probably) visible entrance to the canal incisivus.

	4 & 5 After the extraction we found the reason of previous complications, namely the root fracture. The root canal instrument was also left inside.

	6 The preparation of the recipient site.

	7 The ITI TE Straumann implant ø 4.1/4.8 mm, 12mm long was used.

	8 The control of the correct vertical implant position.

	9 In sagital dimension the implant has to be placed behind the line, connecting the buccal prominence of the adjacent teeth.

	10 X-ray control of the implant placement immediate after surgery.

	11 A temporary acrylic crown inserted a week after implant installation

	12 Three months after.

	13 X-ray control after six months of healing.

	14 Fig 14 demonstrates the soft tissues around the implant neck after six months of conditioning by provisional crown.

	15 The final restoration after cementation.

	16, 17 & 18 Three months later.

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