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Clinical Case Report

Replacement of a Mandibular Central Incisor with an Immediately Placed Monotype Zirconia Implant

Stefan Röhling, Thomas Borer

In this case, immediate implant placement and an immediate provisional prosthetic reconstruction (type 1A) were performed by Stefan Röhling and Thomas Borer to reduce the treatment time and to provide the patient with a fixed implant-supported prosthetic reconstruction directly after implant placement.

A 25-year-old male patient had suffered a traumatic loss of tooth 31 as a child. He was a light smoker (less than 10 cigarettes per day) and in good general health, with an otherwise unremarkable medical history.

Tooth 31 had been immediately re-implanted but not endodontically treated, resulting in external root resorption. Later, the tooth did receive endodontic treatment; the apical part of the root was resected, and the crown was stabilized with composite and attached to the neighboring teeth with a wire.

Surgical classification
Complex
Prosthodontic classification
Complex
Source
Treatment Guide 14
Purchase price
10 Academy Coins
CPD/CME
0.25 hours

Recommended content

General Risk Assessment

Patient-related Factors
Oral hygiene Fair
Compliance Good
Patient-medical Factors
Medical Fitness Healthy, able to undergo planned anesthesia and surgical procedure (ASA I)
Medications No medications that would negatively affect the surgical procedure and outcomes.
Radiation Treatment None
Growth Status Complete
Site-related Factors
Periodontal Status No history of periodontal disease, or any active periodontal disease.
Pathology near the implant site None
Previous surgeries in planned implant site No previous procedures.

Surgical Classification

Surgical Complexity
Timing of placement Immediate Placement (extraction sockets) (Type I)
Simultaneous or Staged grafting procedures Implant placement without adjunctive procedures
Anatomy
Keratinized Tissue Minimal (2-4 mm)
Soft Tissue Quality No scars or inflammation
Proximity to vital anatomic structures Minimal risk of involvement
Adjacent Teeth
Papilla Complete
Recession Absent
Interproximal attachment At CEJ
Extractions
Radicular morphology Uniradicular
Available apical bone to achieve primary stability Sufficient height ( ≥ 4 mm) and width (> 2 mm around apex of planned implant)
Socket walls Intact
Thickness of buccal wall 2mm or greater
Anticipated residual defect after implant placement 2 mm or less

Prosthodontic Classification

Complicating Factors
Biological Cement-retained restorations with appropriate contours
Mechanical/Technical Presence of non-critical contributing factors
Prosthesis Factors
Prosthetic volume Adequate. Space available for ideal anatomy of the restoration
Inter-occlusal space Adequate. Capable to create an anatomically & functionally correct planned restoration
Volume and characteristics of the edentulous ridge (fixed) Adequate. No adjunctive therapy or prosthetic soft tissue replacement will be necessary
Occlusal Factors
Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involved with guidance
Occlusal parafunction Present
Complexity
Loading Protocol Immediate
Implant-supported provisional restoration Required, non-esthetic site and/or functional demands
Timing of placement Immediate Placement (extraction sockets) (Type I)
Publication date: Apr 25, 2024 Last review date: Apr 18, 2024 Next review date: Apr 18, 2027

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