Abstract
The case shows immediate loading in a patient with coronal fracture. A 33-year-old patient with tooth number 24 fractured. A CT scan revealed a chronic periapical lesion of the vestibular root. The patient was treated with a post-extraction of Alpha-Bio Tec's MultiNeOTM implant, xenograft bone regeneration, resorbable collagen membrane and non-functional immediate loading using a PEEK abutment.
Background
Tooth fractures with aesthetic alterations are situations that require efficient and predictable treatments. The post-extraction implant is an example for such a treatment. The osseointegration capacity of the MultiNeOTM implant has been previously demonstrated [1, 2, 3]. There is no significant difference between the postextraction implant and the delayed implant with regard to success rates or peri-implant tissues [4, 5]. Ideal situations have been described for the placement of these implants [6]. Implant placement is not contraindicated in teeth with chronic periapical infections, provided that they are previously curetted and treated with antibiotics [7]. Immediate loading is defined as functional or non-functional loading within 48 hours [8]. The success rate of immediate loading implants is between 96.9% and 98.99% [9, 10]. Because there is no difference between delayed loading implants and immediate loading implants, some practitioners recommend doing immediate loading [11].
It is important to avoid micro-movements during the healing phase [12, 13] which is why we do non-functional immediate loading. The basic requirement for immediate loading is the primary stability of the implant, which depends on the design of the implant, bone quality and milling [14]. The post-extraction immediate loading implant is a procedure that is well documented in the literature.
Case Overview
A 33-year old female patient came for a consultation due to a tooth fracture, requesting a dental implant that has, if possible, a base without palatal coverage. The patient smokes 10 cigarettes per day. No medical history was reported. Extra-oral inspection: Mouth opening of 45mm. High smile line and normal ATM. Normal mastication muscles. Intra oral inspection: Tongue, palate and floor of the mouth are normal. Normal salivation. Normal palate anatomy. Thin gingival biotype. No periodontal disease. Maxilla: Residual root of tooth number 16, coronal fracture of tooth number 24, cavities in numbers 25 and 26, and wear facets on numbers 11 and 21. Fracture of the distal radius of tooth number 22. Mandible: Fillings in 37 and 46. Residual rot of 36. Cavities on the vestibular surface of 34.
Radiographic findings Orthopantomogram: Residual rot was observed in numbers 15 and 36. Coronal fracture of tooth number 24 with radiolucency in the periapical area. CT Scan: Periapical lesion of the vestibular root of tooth number 24 with bone loss was observed at this level.
Materials Used X-ray 3.75 X 13mm MultiNeOTM Implant (Alpha-Bio Tec) PEEK Abutment H 1.0
Treatment Plan
In response to the demands of the patient, who asked for a quick and aesthetic solution for the fracture of tooth number 24, we proceeded to do the following: Surgical Phase It is important to avoid micro-movements during the healing phase [12, 13] which is why we do non-functional immediate loading. The basic requirement for immediate loading is the primary stability of the implant, which depends on the design of the implant, bone quality and milling [14]. The post-extraction immediate loading implant is a procedure that is well documented in the literature. Radiographic findings Orthopantomogram: Residual rot was observed in numbers 15 and 36. Coronal fracture of tooth number 24 with radiolucency in the periapical area. CT Scan: Periapical lesion of the vestibular root of tooth number 24 with bone loss was observed at this level. Materials Used X-ray 3.75 X 13mm MultiNeOTM Implant (Alpha-Bio Tec) PEEK Abutment H 1.0 Atraumatic extraction of tooth number 24 and curettage of the periapical lesion through a fold in the vestibular floor to prevent vertical shocks. Implant placement, xenograft bone regeneration, placement of a resorbable collagen membrane through the vestibular fold and alveolar preservation. Non-functional immediate loading and occlusion control. The treatment was done in one visit to the dental office.
Initial condition
Tooth extraction and site preparation
Implant placement
Non-functional immediate loading
Bone regeneration
Post treatment follow-up
Summary
In this case, the use of the MultiNeOTM implant for postextraction immediate loading in an aesthetic area was a good choice because we achieved primary stability thanks to its design. The prosthetic phase did not present any difficulties due to the accessories that the clinic has for this purpose. The result was predictable, aesthetic and functional in line with the expectations of the professional and the patient. This type of treatment negated the use of removable dentures and shortened the recovery and procedure time.
References
- Anneroth G, Hedstrom KG, Kjellman O, Kondell PA, Nordenram A. (1985) Endosseus titanium implants in extraction sockets. An experimental study in monkeys. International Journal of Oral Surgery 14, 50-54.
- Karabuda C, Sandalli P, Yalcin S, Steflik DE, Parr GR (1999) Histologic and histomorphometric comparison of immediately placed hydroxyapatite-coated and titanium plasma-sprayed implants: a pilot study in dogs. International Journal of Oral and Maxillofacial Implants 14, 510-515.
- Wilson TG Jr, Carnio J, Schenk R, Cochran D. (2003) Immediate implants covered with connective tissue membranes: human biopsies. Journal of Periodontology 74, 402-409.
- Quirynen M, Van Assche N, Botticelli D, Berglundh T. (2007) ¿How does the timing of implant placement to extraction affect outcome? International Journal of Oral and Maxillofacial Implants 22 Suppl, 203-223.
- Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B, Thomsen P. (1991) The soft tissue barrier at implants ans teeth. Clinical Oral Implant Research 2, 81-90.
- Evans CD, Chen ST. (2008) Esthetic outcomes of immediate implant placements. Clinical Oral Implant Research 19, 73-80.
- Novaes A. Immediate implants placed into infected sites: a clinical report. Int J Oral Maxillofac Implants 1995. 10: 609-13.
- Immediately/early loading of dental implants: a report from the Sociedad Española de Implantes, World Congress consensus meeting in Barcelona, Spain, 2002.
- Chiapasco M, Gatti C, Rossi E, Haefliger W, Markwalder TH. (1997) Implant retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res 8:48-57.
- Tarnow DP, Emtiaz S, Classi A. (!997) Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1 ~ to 5 ~ year data. Int J Oral Maxillofac Implants 12:319-329.
- Salama H, Rose LF, Salama M, Betts NJ. (1995) Immediate loading of bilaterally splinted titanium root-form implants in fixed prosthodontics – a technique reexamined: two case reports. Int J Periodontics Restorative Dent 15:344-36.
- Brunski JB. (1991) Influence of biomechanical factors at the bone-biomaterial interface. Mechanical Effects on Interfacial Biology. (Herausgabeort und Verlag einfugen), 391-405.
- Brunski JB. (1992) Biomechanical factors affecting the bonedental implant interface. Clin matter 10:153-201.
- Nentwig GH, Romanos GE. (2002) Sofortversorgung von enossalen Implanten Literaturubersicht und eigene Erfahrungen. Implantologie 10:53-66.
