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Inside Dentistry
June 2015
Volume 11, Issue 6
Peer-Reviewed

Discussion

The patient described in this case report was rehabilitated in one surgical appointment. The fractured implant and adjacent tooth both required removal. The treatment plan for implant replacement of both dental units often involves multiple procedures. While the prospect of immediate implant placement is a well-established treatment modality, the immediate replacement of a root-form implant is, fortunately, a less common occurrence. When implants fracture, inflammation and bone loss are frequently present, which often precludes the possibility of an immediate re-implantation. The coronal, supra-crestal location of the fracture in this situation, as well as the expedient treatment after the fracture, prevented an acute inflammatory reaction in the hard and soft tissues.

The preoperative CBCT scan revealed the presence of healthy bone palatal and apical to the hopeless fixture. It was anticipated that with careful implant removal, an immediate replacement could be attempted. Additional augmentation was done to prevent anticipated ridge-remodeling post implant removal and extraction.8,9 Botticelli and colleagues10 demonstrated the significant negative changes that occur following immediate implant placement.

In this case, an osteotome procedure was performed to elevate the maxillary sinus, with bone augmentation to facilitate implant placement with primary stability. Immediate placement of tooth No. 13 was done simultaneous with replacement of No. 14 implant, and one surgical site was managed with the identical regenerative therapy.

If implant positioning had been compromised based on post-implant removal and extraction-site anatomy, a staged approach would have been proposed prior to surgery. Because prosthetically favorable implant placement was anticipated and performed, immediate placement was done in this case. Because of the nature of the implant removal surgery and need to adapt the dermal barrier beyond the borders of the defect margins, a mucoperiosteal flap was elevated to achieve augmentation and soft-tissue adaptation. The question of ridge-dimension preservation with a “closed” technique has been questioned in the literature.11 Whether this would have affected the esthetic outcome in a posterior site was not as critical as achieving visual access for the efficacy of the procedure.

Conclusion

It was determined that with proper diagnostic information, such as CBCT, radiographs, occlusal analysis, and technique, implant removal and immediate replacement could and was successfully performed in this case.

About the authors

Barry P. Levin, DMD
Diplomate, American Board of Periodontology
Clinical Associate Professor
Department of Periodontology, University of Pennsylvania
Philadelphia, Pennsylvania
Private Practice Limited to Periodontology and Dental Implant Surgery
Elkins Park, Pennsylvania

Michael Weiss, DDS
Board of Directors
Delaware Valley Academy of Osseointegration
Ethics and Affiliate Committees
American Academy of Cosmetic Dentistry
Private Practice in General and Cosmetic Dentistry
Jenkintown, Pennsylvania

References

1. Schropp L, Kostopoulos L, Wenzel A. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: a prospective clinical study. Int J Oral Maxillofac Implants. 2003;18(2):189-199.

2. Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313-323.

3. Cardaropoli D, Gaveglio L, Gherlone E, Cardaropoli G. Soft tissue contour changes at immediate implant: a randomized controlled clinical study. Int J Periodontics Restorative Dent. 2014;34(5):631-637.

4. Parma-Benfenati S, Roncati M, Galletti P, Tinti C. Resorbable dome device and guided bone regeneration: an alternative bony defect treatment around implants. A case series. Int J Periodontics Restorative Dent. 2014;34(6):749-755.

5. Linkevicius T, Puisys A, Linkeviciene L, et al. Crestal bone stability around implants with horizontally matching connection after soft tissue thickening: A prospective clinical trial. [published online ahead of print September 17 2013]. Clin Implant Dent Relat Res. 2013. doi: 10.1111/cid.12155. Accessed January 28, 2015.

6. Cordaro L, Torsello F, Chen S, et al. Implant-supported single tooth restoration in the aesthetic zone: transmucosal and submerged healing provide similar outcome when simultaneous bone augmentation is needed. Clin Oral Implants Res. 2013;24(10):1130-1136.

7. Chen ST, Beagle J, Jensen SS, et al. Consensus statements and recommended clinical procedures regarding surgical techniques. Int J Oral Maxillofac Implants. 2009;24(suppl):S272-S278.

8. Roe P, Kan JY, Rungcharassaeng K, et al. Horizontal and vertical dimensional changes of peri-implant facial bone following immediate placement and provisionalization of maxillary anterior single implants: a 1-year cone beam computed tomography study. Int J Oral Maxillofac Implants. 2012;27(2):393-400.

9. Kan JY, Rungcharassaeng K, Lozada JL, Zimmerman G. Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year follow-up. Int J Oral Maxillofac Implants. 2011;26(1):179-187.

10. Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol. 2004;31(10):820-828.

11. Araújo MG, Lindhe J. Ridge alterations following tooth extraction with and without flap elevation: An experimental study in the dog. Clin Oral Implants Res. 2009;20(6):545-549.

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