Clinicians so often get wrapped up in the technical side of implant dentistry that we forget that a person’s smile is often one of his/her greatest assets and source of pride. Immediate dental implants and restorations when done within known parameters are not only predictable procedures but practice builders as well. This recently happened to me with a patient’s lateral incisor. Tooth No. 7 experienced a vertical fracture rendering it non-restorable. Upon evaluation of the CBCT, I was able to determine that she in fact had good bone volume and was potentially a great candidate for an immediate dental implant with an immediate restoration. My challenge was to extract this tooth with maximum bone preservation and place the implant in an ideal location which will preserve the bony and soft tissue architecture for the final restoration.
The tooth was removed with no bone loss using my favorite instrument, the Zoll-Dental Zator® 3s. The site was curetted to remove any soft tissue remnants and to act as a physical probe for any weak bone or fenestration and irrigated with chlorhexidine (CHX). The trick to these implants, in my opinion, is getting the pilot drill to engage the lingual plate in the clinician’s desired location, not at the apex of the tooth.
With the incisal edge as my landmark for the center of the implant, I was able to place a 4.6 mm x 15 mm BioHorizons® Tapered Plus dental implant into the space along with a temporary crown built upon a PEEK plastic abutment and a vacuum stent made from a mold of her original tooth. The temporary was trimmed, contoured, and polished for seating. As you can imagine, the occlusion and excursions of this restoration are of the utmost importance as we want to minimize the lateral forces on this restoration. The end result was esthetically pleasing, done in the same appointment, and has set up the final restoration for success.
Stay tuned as the next column will talk about the final restoration and the digital workflow.
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