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SHORT COMMUNICATION Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 454-456
Restoration of the maxillary anterior tooth using immediate implantation with simultaneous ridge augmentation


Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA

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Date of Submission15-Aug-2009
Date of Decision09-Sep-2009
Date of Acceptance23-Jan-2010
Date of Web Publication29-Sep-2010
 

   Abstract 

Atrophy is most severe during the first month of post-extraction in the anterior maxilla with the degree of horizontal bone resorption being nearly twice as high as that of vertical bone resorption. The loss of the buccal alveolar plate following tooth extraction may lead to palatal implant positioning of the implants. Thus, immediate or early implant placement in the extraction socket has been suggested, because it would reduce the time period and the number of surgical intervention and yield higher patient satisfaction compared with delayed placed implants. However, placement of an implant immediately after tooth extraction may result in a gap between the occlusal portion of the implant and the surrounding alveolar bone crest. In this case report, an implant-supported restoration which is in harmony with the surrounding hard and soft tissue was created by the immediate implant placement with ridge augmentation in anterior region with high satisfaction from the patient.

Keywords: Anterior, immediate, ridge augmentation

How to cite this article:
Park JB. Restoration of the maxillary anterior tooth using immediate implantation with simultaneous ridge augmentation. Indian J Dent Res 2010;21:454-6

How to cite this URL:
Park JB. Restoration of the maxillary anterior tooth using immediate implantation with simultaneous ridge augmentation. Indian J Dent Res [serial online] 2010 [cited 2019 Sep 18];21:454-6. Available from: http://www.ijdr.in/text.asp?2010/21/3/454/70791
In the anterior maxilla, atrophy is most severe during the first month of post-extraction and the loss of the buccal alveolar plate following tooth extraction may lead to palatal implant positioning of the implants. [1]

Thus, immediate or early implant placement in the extraction socket has been suggested because it would reduce the time period and the number of surgical intervention and yield higher patient satisfaction compared with delayed placed implants. [2] However, placement of an implant immediately after tooth extraction may result in a gap between the occlusal portion of the implant and the surrounding alveolar bone crest. [1]

In this case report, an implant-supported restoration which is in harmony with the surrounding hard and soft tissue was created by the immediate implant placement with ridge augmentation in anterior region with high satisfaction from the patient.


   Case Report Top


A 20-year-old male patient visited the dental clinic, for evaluation of the upper anterior region. The patient did not have any medical conditions that were associated with a compromised healing response. Clinical and radiographic examination showed deep subgingival fracture on palatal side with unfavorable prognosis [Figure 1]. The missing area had the mesiodistal space of 5 mm and disharmony in gingival margin with crowding was seen in the anterior region. The patient was referred to the Department of Prosthodontics and Orthodontics for further evaluation and treatment planning. The patient was given a detailed explanation concerning the present state, alternative treatment plans, and the procedure, and informed consent was obtained from the patient. Treatment with immediate placement of dental implant with simultaneous ridge augmentation was planned after the consultation.
Figure 1: Clinical photograph at the initial visit showing deep subgingival fracture on palatal side

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Immediately before the procedure, the patient rinsed for 2 minutes with a 0.12% chlorhexidine digluconate solution (Hexamedine, Bukwang, Seoul, Korea). Following an injection of 2% lidocaine with 1:100,000 epinephrine temporary prosthesis was connected and the screw hole was sealed with light-cured resin (Fuji II LC, GC, Alsip, IL, USA) added by layers.

After 4 weeks of soft tissue adaptation, the permanent restoration was delivered. The prosthesis was well in local anesthetic, the remaining root portion was removed atraumatically. The extraction socket was thoroughly debrided and degranulated to remove all the tissue. A surgical template was used to locate the desired implant position. The area was prepared to accept a 4.1 × 15 mm implant (Avana® , Osstem, Seoul, Korea). The implant was placed with the insertion torque of 40 Ncm. An impression was obtained at the time of surgery with the aid of the surgical stent by connecting the implant holder and the stent using autopolymerizing resin [Figure 2]. After hand-tightening the abutment, marginal gap voids about 2-3 mm in width were noted between the implant surface and the buccal cortex. The marginal voids were grafted with deproteinized bovine bone (Bio-Oss® , Geistlich AG, Wolhusen, Switzerland) [Figure 3]. The flap was repositioned and the wound was closed by means of single sutures. The patient was placed on amoxicillin 500 mg thrice daily for 5 days, mefenamic acid 500 mg initially, then 250 mg four times daily for 5 days, and chlorhexidine digluconate 0.12% twice daily for 2 weeks. The implant analog was fixed to the impression holder and was sent to the laboratory for the temporary prosthesis.
Figure 2: The implant holder was connected to the stent with the autopolymerizing resin

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Figure 3: Marginal gap voids about 2-3 mm in width were grafted with deproteinized bovine bone

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The patient reported no specific symptoms and he did not show any adverse clinical signs. Good soft tissue healing was achieved with well-maintained ridge, which could be seen after the removal of the abutment [Figure 4]. The function up to the final evaluation. The soft tissue health and the width of the ridge were well maintained with good esthetic result [Figure 5] and [Figure 6].
Figure 4: Good soft tissue healing was achieved

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Figure 5: Panoramic radiograph taken at the final examination

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Figure 6: The prosthesis was functioning well without any probing depth or gingival inflammation up to final evaluation

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   Discussion Top


In this case report, the harmony of soft and hard tissue was achieved by immediate implant placement with ridge augmentation in maxillary anterior region. Additionally, the surgical stent was used not only in the diagnosis step but also in the implant operation and the impression procedure, and thus reduction in the number of surgeries and treatment time. [3] Using the stent in the impression procedure prevented the contact of the impression material with the soft and hard tissue of the patient.

Placement of an implant immediately after tooth extraction may result in a gap between the occlusal portion of the implant and the surrounding alveolar bone crest. [1] Soft tissue deficiency and very thin buccal alveolar ridge were revealed after the extraction of the root portion. Overcorrection of the alveolar ridge was done to compensate for the undesirable alteration in the tissue volume. [4]

Insufficient keratinized tissue around the implant may increase the risk of gingival recession and the crestal bone loss. [5] Soft tissue closure over immediate implants may result in the disharmony of the gingival contour and the loss of keratinized tissue. And apically positioned flap or free gingival graft may be needed to increase the width of the keratinized tissue.

The harmony of soft and hard tissue was achieved by immediate implant placement with bone augmentation in esthetically challenging situation. Additionally, the surgical stent was used in the diagnosis, implant surgery, and the impression procedure to reduce the treatment time. Immediate placement of implants with simultaneous ridge augmentation may be a treatment option with higher patient satisfaction compared with conventional delayed approach. Further evaluation is needed to monitor hard and soft tissue changes on a long-term basis.

 
   References Top

1.Younis L, Taher A, Abu-Hassan MI, Tin O. Evaluation of bone healing following immediate and delayed dental implant placement. J Contemp Dent Pract 2009;10:35-42.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Quirynen M, Van Assche N, Botticelli D, Berglundh T. How does the timing of implant placement to extraction affect outcome? Int J Oral Maxillofac Implants 2007;22:203-23.  Back to cited text no. 2  [PUBMED]    
3.Fernandes A. Implantology 101. Dent Today 2007;26:100,102,104 passim.  Back to cited text no. 3  [PUBMED]    
4.Chiapasco M, Abati S, Romeo E, Vogel G. Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges. Clin Oral Implants Res 1999;10:278-88.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, et al. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e24-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Jun-Beom Park
Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.70791

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

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