Article 11

Immediate Loading Post-extraction Implant in the Aesthetic Region Following Trauma

 

Dr. Emil Sild Freelancer in Bologna

The patient, a 65-year-old woman, a smoker with an average of ten cigarettes a day, with decent general clinical features, came to our observation with an abscess in region 12 as a result of a mechanical trauma that occurred two weeks ago by a bunch of keys. On oral examination, a fistula in region 12 (fig. 1) was noted, with horizontal mobility of the crown and vestibular probing of 7 mm with a discharge of pus. The radiograph in region 12 (fig. 2) showed a metal pin and a metal-ceramic crown, without evident signs of bone resorption.

 

It was decided to intervene with the extraction of the No. 12 tooth and simultaneous insertion of an implant with a provisional crown to meet the aesthetic requirement of the patient. Impressions were taken to prepare a temporary resin to be applied at the end of the surgery, performed under local anesthesia, under antibiotic coverage (Augmentin 1g every 12 hours for six days). After opening a vestibular flap and extracting the root of 12, careful surgical practice of the recipient site was performed, and then a Vega implant with ContacTi was inserted.(Klockner Implant System) (fig. 3). The implant was inserted approximately 1 mm more apical than the palatal bone crest. Excellent primary stability was achieved despite the lack of the buccal bone wall for a depth of 4 mm from the bone crest (Fig. 3).

 

 

After screwing a titanium abutment for a temporary restoration onto the implant, the previously prepared resin shell was relined directly in the mouth (fig. 4). The provisional was then finished, polished, and screwed back without functional load. Before suturing the flap, a bovine origin bone substitute in granules (Ti-oss®) was buccally grafted to reconstruct the missing vestibular wall. No membrane was applied, but the flap was closed by suturing (fig. 5). The intraoperative radiograph showed correct implant insertion (fig. 6 on the left). The post-operative one showed an excellent provisional fit (fig. 6 on the right).

 

 

The sutures were removed two weeks after surgery. After two months, the soft tissues showed excellent healing (Fig. 7), and the final impressions were taken for finalizing the case. A definitive straight abutment was used, modified following the principles of Ignazio Loi's Bopt technique. The metal-ceramic crown was also made based on the same principles. The soft tissues showed good adaptation after final cementation (fig. 8), and the control radiograph showed an excellent fit of both the crown and abutment (fig. 9).

 

 

The use of the Vega implant made it possible to obtain excellent primary stability with the possibility of carrying out an immediate post-extraction load. In addition, the ContacTi implant surface led to excellent osseointegration in two months, allowing for a rapid and satisfactory clinical result.

Fig. 1
Fig. 1

Elemento 12 con presenza di fi a due settimane dal trauma

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Fig. 2
Fig. 2

Radiografi elemento 12 al momento della prima visita

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Fig. 3
Fig. 3

Impianto Vega ContacTi 4,5 x 10 mm. Assenza della parete ossea vestibolare per 4 mm di profondità. Ottima stabilità primaria

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Fig. 4
Fig. 4

Ribasamento del provvisorio avvitato durante la chirurgia

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Fig. 5
Fig. 5

Provvisorio in resina avvitato e sutura dei lembi

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Fig. 6
Fig. 6

A sinistra, radiografi dopo inserimento impianto; a destra, radiografi dopo avvitamento provvisorio e inserimento del biomateriale

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Fig. 7
Fig. 7

Guarigione dei tessuti molli a due mesi dall'intervento

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Fig. 8
Fig. 8

Corona in metallo-ceramica cementata

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Fig. 9
Fig. 9

Radiografi a due mesi, dopo cementazione della corona in metallo-ceramica

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