According to the classic Branemark protocol for implant placement, the insertion of an implant after tooth extraction requires a waiting period of 3-6 months defined as the healing process, before surgery can be performed, followed by another 3-6 months of time for implant osseointegration, thus increasing the treatment time for both clinicians and patients. However, thanks to current knowledge and experience, and to new technologies applied to implant manufacturing, it is now possible to obtain new implants with particular macro and microstructures that allow immediate implant insertion into immediate post-extraction sockets with a survival rate of 95% to 100% and with a success rate ranging from 89% to 98% for 5 to 10 years.
Post-extraction implants can also offer multiple advantages, including shorter treatment times because the healing of the socket and the osseointegration of the implant occur simultaneously; less psychophysical stress for the patient; ideal prosthetic insertion of the implant thanks to the preservation of the anatomical site, which allows for correct insertion of the fixture; and, above all, when combined with the use of a biomaterial and a connective tissue graft, at least partial maintenance of the buccal bone plate, which usually resorbs following an extraction. This is necessary for achieving an ideal aesthetic result and for maintaining the vestibular bump, an essential factor for a natural appearance of implant-prosthetic restorations (RBP: Root Bump Preservation).
Fig.1
A 34-year-old female patient presented to our clinic complaining of mobility and yellowish color of the upper right central incisor.
Fig.2
The right central incisor effectively appears darker in color and it is really mobile.
Considering that the soft tissue profile was ideal, it was decided to have a temporary restoration prepared for the day of surgery that exactly replicated the emergence profile of the tooth to be extracted, so as to correctly support the soft tissues and not create any changes in shape during the healing phases.
Fig.3
The x-ray shows a severe resorption of its root, clearly describing the reason for its mobility.
Fig.4
Just after extracting the tooth and placing the implant, a dermal matrix was tunneled between the buccal bone wall and the soft tissues.
Fig.5
The gap between the implant and the alveolar bone walls was then filled with heterologous biomaterial, taking great care not to compact it too much to allow the blood to permeate it completely.
Fig.6
The presence of the dermal matrix and the biomaterial grains positioned flush with the free gingival margin is clearly visible to improve as much as possible the maintenance of the emergence profile and the presence of the root bump.
Fig.7
The provisional restoration just screwed at the end of the surgery.
Fig.8
14 days after surgery, a significant inflammatory reaction is still present, probably due to the metabolism of the dermal matrix.
Fig.9
X-Ray at the end of the surgery.
Fig.10
One year after surgery, the peri-implant tissues are very good in terms of shape, tone, and health. The papillae are competent, and the parabola is symmetrical to that of the adjacent tooth.
Fig.11
The root bump is very well preserved (Root Bump Preservation RBP).
Fig.12
The definitive screw-retained zirconia ceramic crown. The shape, color, and especially the emergence profile are completely similar to the adjacent tooth, making the restoration very natural and almost invisible at a normal viewing distance.
Fig.13
Final X-Ray at 15 months from the surgery.
Conclusions
Aesthetic and functional rehabilitation often involves an unconventional approach.
A correct anatomical and aesthetic diagnosis, an appropriate treatment plan, and careful selection of materials are critical factors for the success of the restoration.
The ability to preserve an already ideal anatomy is certainly an important starting point for the correct solution of the case, along with the ability to manage both the surgical part and the shape of the prosthetic restorations in order to maintain a satisfactory functional and aesthetic result over time.
Moreover, the use of a screw-retained restoration with a transmucosal portion capable of faitfully replicating the transmucosal path created by the correct contour of the temporary restoration is a prerequisite for achieving optimal results.
Bibliography
- R Saito H, Chu S, Reynolds M, Tarnow D: “Provisional Restorations Used in Immediate Implant Placement Provide a Platform to Promote Peri-implant Soft Tissue Healing: A Pilot Study “ Int J Period Rest Dent 2016;36:47-52;
- Redemagni M, Cremonesi S, Garlini G, Maiorana C: “Soft Tissue Stability with Immediate Implants and Concave Abutments.” Eur J Esthet Dent 2009;4:226-235;
- Mankoo T: “Contemporary implant concepts in aesthetic dentistry-Part 2: immediate single tooth implants.” Pract Proced Aesthet Dent 2004;16:61-68;
