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Clinical Case Report

TG14 - Immediate Implant Placement with Static Computer-Aided Implant Surgery and Immediate Loading in the Esthetic Zone with Prefabricated CAD/CAM Provisional Implant Restorations

Alejandro Lanis, Luiz Henrique Gonzaga, Adam Hamilton

The type 1A protocol for immediate implant placement and immediate loading is defined as a surgical and prosthodontic procedure where dental implants are placed in the extraction socket on the same day the tooth is extracted and a restoration is delivered immediately (Morton and coworkers 2018; Gallucci and coworkers 2018). In the esthetic zone, the success of this approach depends on several factors, such as an adequate diagnosis, appropriate patient selection, favorable alveolar anatomy, suitable conditions at and characteristics of the surgical site, and proper training and sufficient experience on the part of the clinician (Levine and coworkers 2017; Chappuis and coworkers 2013; Belser and coworkers 2009; Chen and Buser 2014). Although long-term treatment predictability is intimately related to the described variables in these cases, and only a limited patient cohort meets all the criteria for this type of treatment, “immediacy” has been gaining popularity with clinicians and patients worldwide (Sans-Sánchez and coworkers 2015; Buser and coworkers 2017a).

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
Smoking Habit None
Oral hygiene Good
Compliance Good
Patient's Expectations High but achievable
Patient-medical Factors
Medical Status Healthy, uneventful healing
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.
Access Adequate
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 with simultaneous hard and soft tissue procedures
Number of implants Two - Three
Anatomy
Bone Volume - Horizontal Adequate
Bone Volume - Vertical Adequate
Keratinized Tissue Sufficient (>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 Screw-retained restorations with appropriate contours
Mechanical/Technical Absence of contributing factors
Planned contour of tissue-fitting surfaces Appropriate contours (hygienic - accessible for maintenance)
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
Esthetic Factors
Gingival display at full smile High
Shape of tooth crowns Rectangular
Restorative status of neighboring teeth Virgin
Gingival Phenotype Low-scalloped, thick
Bone level on adjacent teeth ≤5 mm to contact point
Occlusal Factors
Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involved with guidance
Occlusal parafunction Absent
Complexity
Loading Protocol Immediate
Implant-supported provisional restoration Required, elevated esthetic and/or functional demands
Timing of placement Immediate Placement (extraction sockets) (Type I)

Esthetic Risk Assessment

Esthetic Risk Assessment
Medical Status Healthy, uneventful healing
Smoking Habit None
Gingival display at full smile High
Width of edentulous span 1 tooth (≥ 7mm, standard diameter implant) 1 Tooth (≥ 6mm, narrow diameter implant)
Shape of tooth crowns Rectangular
Restorative status of neighboring teeth Virgin
Gingival Phenotype Low-scalloped, thick
Infection at implant site None
Bone level on adjacent teeth ≤5 mm to contact point
Thickness of buccal wall 2mm or greater
Patient's Expectations High but achievable
Publication date: Oct 27, 2023 Last review date: Oct 20, 2023 Next review date: Oct 20, 2026

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