Journal of Dental Implants
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Table of Contents
CASE REPORT
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 177-180

Immediate implant placement in mandibular anterior region with dehiscence


1 Department of Prosthodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Conservative Dentistry, Faculty of Dental Sciences, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Orthodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication25-Sep-2013

Correspondence Address:
Romesh Soni
Department of Prosthodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.118864

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   Abstract 

Restoration of teeth in the esthetic zone is a great challenge for dental practitioners. Preference to shortened overall treatment period and minimum number of surgical interventions in implant dentistry is desired by patients and clinicians. Immediate implant placement combined with simultaneously guided bone regeneration in post extraction sockets having bony defects has emerged as a predictable method resulting in high implant survival rates and good esthetic outcomes. This article describes a case of immediate implant placement and guided bone regeneration for treatment of severe buccal dehiscence in mandibular anterior region.

Keywords: Dehiscence, guided bone regeneration, immediate implant placement, peri-implant esthetics


How to cite this article:
Soni R, Singh A, Vivek R, Baranwal H C, Chaturvedi T P, Srivastava A. Immediate implant placement in mandibular anterior region with dehiscence. J Dent Implant 2013;3:177-80

How to cite this URL:
Soni R, Singh A, Vivek R, Baranwal H C, Chaturvedi T P, Srivastava A. Immediate implant placement in mandibular anterior region with dehiscence. J Dent Implant [serial online] 2013 [cited 2019 Nov 21];3:177-80. Available from: http://www.jdionline.org/text.asp?2013/3/2/177/118864


   Introduction Top


Alveolar ridge resorption has been an unavoidable phenomenon following tooth extraction. When a tooth is extracted, predictable bone loss is accelerated in the first 6 months with as much as 40% of the alveolar height and 60% of the alveolar width loss, which continues at a rate of 0.25% to 0.5% per year. [1] Traditional guidelines advise a 2-3 month period of socket remodeling after tooth extraction and an additional 3-6 months of load-free healing, which was essential for osseointegration in the 1980s. [2] Alternative protocols such as immediate implant placement at the time of extraction [3] and a method of early implant insertion after a few weeks of soft-tissue healing [4] have been used for about 20 years. Immediate implant placement has many advantages, such as preservation of crest bone, reduction in the number and complexity of surgical procedures, reduction of the edentulous period, and increased patient acceptance. The advantages of only one surgical procedure and reducing the overall treatment time have encouraged clinicians to immediately install implant fixtures into extraction sockets. [5] Simultaneously guided bone regeneration (GBR) procedures, using bone grafts and barrier membranes, are usually necessary in such a situation to correct peri-implant defects and/or to augment surrounding tissues. This approach can also achieve successful treatment outcomes with high predictability and a low risk of complications, both from functional and esthetic points of view. [4]

Advanced periodontitis, unrestorable caries, fractures, and traumatic injuries are the most common reasons for missing anterior teeth. The appearance of metal or resin connectors in fixed partial dentures and the inconvenience of removable dentures can bother patients with high esthetic and psychological demands. Thus, practitioners encounter increasing numbers of implants that need to be placed in the anterior esthetic zone with high esthetic expectations from patients. The preference of shortened overall treatment period and minimum number of surgical interventions are expected by patients and clinicians. Recently, many studies have also reported that immediate implant following minimally invasive extraction is contributive to preserving the crest bone and the interdental papillae, thus improving peri-implant esthetics. [6],[7]

The purpose of this article is to present a case of periodontally compromised anterior teeth associated with bone loss using immediate implant placement combined with simultaneous GBR to correct a severe buccal dehiscent defect.


   Case Report Top


A 35-years-old non-smoking male patient reported to the department of prosthodontics with the chief complaint of mild discomfort on biting and tooth mobility in the mandibular anterior region. He also complained of unaesthetic appearance due to missing left mandibular lateral incisor and gingival recession [Figure 1]. Medical history was noncontributory. Intraoral examination findings included severe gingival recession in mandibular region in relation to 31, 41 and 42 with grade 3 mobility and having hopeless prognosis.
Figure 1: Frontal view showing missing left mandibular lateral incisor and gingival recession

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Radiographic examination was done. Denta scan revealed severe buccal dehiscence [Figure 2]. Various treatment options were discussed with the patient. Based on patient's desire of reduced number of surgical procedures and overall treatment time, immediate implant placement after tooth extraction of 31,41, and 42 was decided as the final treatment plan.
Figure 2: Denta scan revealing severe buccal dehiscence

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Informed consent was obtained. Surgical phase was initiated with administration of local anesthesia (lidocaine with epinephrine 1:100,000). A traumatic tooth extraction with periotomes was performed [Figure 3]. The extraction socket was thoroughly debrided with caution to prevent fracture of thin buccal plate. Implant bed preparation was completed after standard protocols using incremental sharp spiral drills and copious chilled saline. Following socket debridement, an implant of 3.75 × 11 mm (Hi-tech, Herzlia, Israel) was placed in 32 and 42 position [Figure 4] and [Figure 5] according to the manufacturer's protocol and with reference to three-dimensional positioning. Adequate initial stability was obtained when placed with a torque driver at 35 Ncm. The dehiscent-type defect on the buccal wall was identified. A localized GBR procedure was then undertaken using bone grafts (Osteohealth, Shirley, NY) and a collagen membrane (Shell bridge Way, Richmond, USA) [Figure 6] and [Figure 7] followed by placement of interrupted sutures.
Figure 3: Atraumatically extracted teeth

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Figure 4: Implants placed along with impression coping

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Figure 5: Implants placed in 32 and 42 positions

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Figure 6: Bone graft placed in the osteotomy site

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Figure 7: Collagen membrane placed over the bone graft and implant

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Patient was recalled after 6 months for follow-up. Second stage surgery was done and healing cap was placed [Figure 8]. After 2 weeks prosthetic phase was performed. Fixed ceramo-metal FP 3 prosthesis [Figure 9] was fabricated with gingival ceramics in gingival recession areas. Loading of the prosthesis was done. Gingival prosthesis was recommended to the patient for remaining mandibular teeth showing gingival recession.
Figure 8: Healing cap in place after second stage surgery

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Figure 9: FP 3 prosthesis placed

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The 18-month follow-up examination revealed stable, healthy peri-implant soft tissue. The patient was also satisfied with the esthetic and functional outcome.


   Discussion Top


The progressive involution of the alveolar bone begins following tooth extraction, and it is usually accompanied by reductions in both the quality and quantity of hard tissue. It was shown that major changes in an extraction site occur in the first 3-12 months after tooth extraction, and an estimated 50% decrease in buccolingual width was demonstrated. [8] Implants placing immediately after tooth extractioncan eliminate the waiting period for socket healing and may reduce the bone resorption that normally occurs following the loss of a tooth. [9]

To enhance peri-implant bone healing and achieve an esthetic final outcome, the use of barrier membranes and/or different graft materials to fill in residual peri-implant defects has been widely documented. [10],[11],[12] Barrier membranes may prevent connective tissue and epithelium from invading the gap between the implant and the surrounding bone walls, thereby favoring bone regeneration. [13],[14] Grafting materials can, moreover, act as a space maintainer and promote bone formation. [12],[15],[16]

Many studies have shown the successful use of various graft materials, including autogenous grafts, [17],[18] freeze-dried bone allografts, [19],[20] xenografts [12],[16] and synthetic bone grafts, [21],[22] in the reconstruction of peri- implant defects in cases of immediate implant placement. Kan and Rungcharassaeng [7] claimed that the necessity of bone grafts depends on the thickness of labialplate rather than the size of the gap. Although a thick labial plate is generally resistant to resorption, which makes grafting unnecessary, bone grafting is frequently used to prevent collapse and minimize resorption of the thin labial plate, regardless of the gap size.


   Conclusion Top


Immediate implant placement following extraction is a viable option for the management of a malaligned tooth with localized severe chronic periodontitis. The protocol described reduces the clinical treatment time. However, this protocol should only be used for selected situations when the clinical condition allows an esthetic outcome.

 
   References Top

1.Iabella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: A clinical histologic study in humans. J Periodontol 2003;74:990-9.  Back to cited text no. 1
    
2.Albrektsson T, Branemark PI, Hansson HA, Lindstrom J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 1981;52:155-70.  Back to cited text no. 2
    
3.Lazzara RM. Immediate implant placement into extraction sites: Surgical and restorative advantages. Int J Periodontics Restorative Dent 1989;9:333-43  Back to cited text no. 3
    
4.Chen S, Wilson Jr TG, Ha¨mmerle CH. Immediate or early placement of implants following tooth extraction: Review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants 2004;19(Suppl):12-25.  Back to cited text no. 4
    
5.Chen S, Buser D. Advantages and disadvantages of treatment options for implant placement in post-extraction sites. In: Buser D, Wismeijer D, Belser UC, editors. ITI Treatment Guide. Implant Placement in Post-extraction Sites e Treatment Options. vol. 3. Berlin: Quintessence; 2008. p. 36.  Back to cited text no. 5
    
6.Becker W. Immediate implant placement: Diagnosis, treatment planning and treatment steps/or successful outcomes. J Calif Dent Assoc 2005;33:303-10.  Back to cited text no. 6
    
7.Kan JY, Rungcharassaeng K. Interimplant papilla preservation in the esthetic zone: A report of six consecutive cases. Int J Periodontics Restorative Dent 2003;23:249-59.  Back to cited text no. 7
    
8.Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: A clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 2003;23:313-23.  Back to cited text no. 8
    
9.Werbitt MJ, Goldberg PV. The immediate implant: Bone preservation and bone regeneration. Int J Periodontics Restorative Dent 1992;12:206-17.  Back to cited text no. 9
    
10.Becker W, Dahlin C, Becker BE, Lekholm U, van Steenberghe D, Higuchi K, et al. The use of e-PTFE barrier membranes for bone promotion around titanium implants placed into extraction sockets: A prospective multicenter study. Int J Oral Maxillofac Implants 1994;9:31-40.  Back to cited text no. 10
    
11.Augthun M, Yildirim M, Spiekermann H, Biesterfeld S. Healing of bone defects in combination with immediate implants using the membrane technique. Int J Oral Maxillofac Implants 1995;10:421-8.  Back to cited text no. 11
    
12.Nemcovsky CE, Moses O, Artzi Z, Gelernter I. Clinical coverage of dehiscence defects in immediate implant procedures: Three surgical modalities to achieve primary soft tissue closure. Int J Oral Maxillofac Implants 2000;15:843-52.  Back to cited text no. 12
    
13.Becker W, Becker BE, Handelsman M, Ochsenbein C, Albrektsson T. Guided tissue regeneration for implants placed into extraction sockets: A study in dogs. J Periodontol 1991; 62:703-9.  Back to cited text no. 13
    
14.Botticelli D, Berglundh T, Buser D, Lindhe J. The jumping distance revisited: An experimental study in the dog. Clin Oral Implants Res 2003;14:35-42.  Back to cited text no. 14
    
15.Botticelli D, Berglundh T, Lindhe J. The influence of a biomaterial on the closure of a marginal hard tissue defect adjacent to implants: An experimental study in the dog. Clin Oral Implants Res 2004;15:285-92.  Back to cited text no. 15
    
16.Chen ST, Darby IB, Reynolds EC. A prospective clinical study of non-submerged immediate implants: Clinical outcomes and esthetic results. Clin Oral Implants Res 2007;18:552-62.  Back to cited text no. 16
    
17.Becker W, Becker BE, Polizzi G, Bergstrom C. Autogenous bone grafting defects adjacent to implants placed into immediate extraction sockets in patients: A prospective study. Int J Oral Maxillofac Implants 1994;9:389-96.  Back to cited text no. 17
    
18.Chen ST, Darby IB, Adams GG, Reynolds EC. A prospective clinical study of bone augmentation techniques at immediate implants. Clin Oral Implants Res 2005;16:176-84.  Back to cited text no. 18
    
19.Gelb DA. Immediate implant surgery: Three-year retrospective evaluation of 50 consecutive cases. Int J Oral Maxillofac Implants 1993;8:388-99.  Back to cited text no. 19
    
20.Babbush CA. The use of a new allograft material for osseous reconstruction associated with dental implants. Implant Dent 1998;7:205-12.  Back to cited text no. 20
    
21.Glickman RS, Bae R, Karlis V. A model to evaluate bone substitutes for immediate implant placement. Implant Dent 2001;10:209-15.  Back to cited text no. 21
    
22.Novaes AB Jr, Papalexiou V, Luczyszyn SM, Muglia VA, Souza SL, Taba Junior M. Immediate implant in extraction socket with acellular dermal matrix graft and bioactive glass: A case report. Implant Dent 2002;11:343-8.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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