Immediate Implant Restoration Case Study: A case of maxillary anterior tooth trauma extraction and restoration

Jul 6

2 min read

Pre-operation Examination

Extraoral examination: The facial features are basically symmetrical on both sides, and the mouth opening is normal, about 38mm. There is no clicking or murmur in the mandibular joint.

Intraoral examination: The gums are not red, swollen, or painful, and there are plaques and a small amount of calculus. 12, 13, 14, 45, 46, 47 are restored with metal porcelain crowns; 22 has white filling visible on the inner surface; 21, 22 are percussed (+), II° loose, overbite is normal, the occlusion is stable when the cusps are staggered, and the occlusion is basically symmetrical when the two sides are occluded.

Patient Background

Name: Zhang

Gender: Male

Age: 47

Allergy: None

Cause: Patient accidentally hit his anterior teeth and affect his chewing

CBCT Examination

21, 22 crown root fracture. 21 labial fracture is located about 8mm below the gum, palatal fracture is located about 2mm below the gum, labial bone plate is relatively continuous, root apex has no obvious abnormality. 22 labial and lingual fracture is located about 2mm below the gum, root apex has no obvious abnormality. It can be seen that the alveolar ridge of the adjacent teeth is high enough.

Surgical design plan

21, 22 After consultation with endodontists, the long-term effect of 21, 22 post crown restoration is not good, and it is recommended to remove it and then perform implant surgery
21, 22 Immediate implantation and immediate restoration
Surgical material: Ostem (TS3M3513C) 3.75*13Lmm x 2

Surgical procedure

Treatment goal:

21, 22 Immediate implantation and immediate restoration

Treatment plan:

21, 22 Minimally invasive extraction followed by immediate restoration, immediate implantation depending on initial stability
Use soft tissue induction molding for temporary restorations
Permanent restoration
Regular examinations

Routine oral and maxillofacial disinfection and intraoral disinfection, covered with sterile cloths, local infiltration anesthesia with 1.7ml of articaine hydrochloride and epinephrine x 2 vials at the implantation site. Gum separation after the anesthetic takes effect. Incisions at 11 and 23, mucoperiosteal flaps, gradual extraction of affected teeth, and preservation of the integrity of the labial bone wall.

The bone surface was cleaned and scraped, and the central holes of the 21 and 22 alveolar sockets were prepared step by step under cooling with normal saline. The patient bone density is second-class bone and bleeding were active. The pilot drill was positioned, and the parallel measuring rod was placed for CBCT shooting and positioning.

Under normal saline and gradually cooling method, placed implant into the prepared hole with 35N. The implant is located 1-2 mm below the bone. A healing abutment is placed, the labial side is covered with an absorbable membrane barrier, fixed with membrane pins, 0.25 g of Bio-oss bone graft is implanted, and tension-reducing sutures are performed.

Take impression of the intraoral condition to perform immediate restoration. Install impression analog, and prepare silicon rubber mixture to capture intraoral impression.