Due to the high requirements of patients for aesthetics in the smile area, the restoration of removed incisors in the upper jaw is currently considered the main indication for performing immediate implantation.
The 23-year-old patient applied for dental care. The Central incisor of the upper jaw was evaluated. The main complaint of the patient was the presence of slight tooth mobility, which was caused by an injury that occurred 10 years ago. The collection of anamnesis showed that there were no symptoms of pain at the time of the injury or in subsequent years.
The patient's treatment plan
After performing a cone-beam computed tomography, the treatment plan was drafted. The proposed treatment plan consisted of atraumatic tooth extraction followed by immediate placement of the dental implant, together with a bone graft (bovine bone) to fill the gap, and a subepithelial connective tissue graft to stabilize the periodontal soft tissues. Restorative procedures included immediate provisionalization of the implant using an extracted clinical crown adapted as a temporary crown. The rationale for the proposed treatment plan was to ensure that the patient's aesthetics were maintained while restoring the function of the lost element.
Surgical procedures were performed under local infiltration anesthesia. A morse tapered implant (MT, length 3.5 mm x 11.5 mm, Neodent, instradent.us) was installed 3 mm apical to the gingival margin (according to the manufacturer's instructions) in the prepared surgical site.
Between the implant and the buccal bone plate (Lumina-Bone, Critéria, criteria.com.br) a 1-mm thick bovine graft was placed to fill each present gap, while a second graft (from harvested connective tissue) was placed over the first graft to serve as a biological barrier during the healing process and to increase the gingival volume.
The selected clinical crown was then separated from the root, prepared and adjusted so that it corresponded to the orthopedic abutment of the implant. It was fixed using a light cure resin (shade A2, Empress® Direct, Ivoclar Vivadent, ivoclarvivadent.com). The adapted crown was screwed into the implant and occlusal adjustments were made to avoid super-contacts (centrally, laterally and in the front position).
The proposed treatment plan included an immediate implant placement protocol followed by immediate provisionalization of the implant using the crown of the patient's extracted tooth. The treatment plan led to immediate aesthetic results for the patient while maintaining the natural contours of the gums and gingival papillae.
The obtained results clearly show that the using protocol of treatment has led to the long-term preservation of the contours and volume of the gums.
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