Dentist Area - Special Case 1

Dental Implants, Immediate or Delayed Placement

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A patient was referred to Smile Clinic, dental surgery London complaining of heavily broken UL5. The tooth had a history of failing root canal treatment with fractured retained post for 3 months (Fig 1).

The prognosis of the tooth was poor and the patient was advised by Dr Daoudi, specialist and cosmetic dentist to have the tooth extracted. The patient was presented with different treatment options to manage the resultant gap including:

Do nothing, provision of fixed or removable partial denture or dental implant.

As the patient expressed her wishes to proceed with the implant option, a decision had to be made on the timing of implant placement.

It is crucial to meet patient’s expectations of providing a quick and acceptable replacement to the missing tooth. However, one should not compromise on the quality of the delivered care.

To clarify some of the used terms with dental implant dentistry, I prefer to use Cochran library terms as follows:

Timing of implant placement:

• Immediate dental implants: any dental implant placed in a fresh extraction socket just after tooth extraction.
• Immediate-delayed dental implants: any dental implant placed in a extraction socket within 8 weeks after tooth extraction.
• Delayed dental implants: any dental implants placed at least 2 months after tooth extraction.

Dental Implant loading:

• Immediate loading: any dental implant put in function within 1 week after its placement.
• Early loading: those dental implants put in function between 1 week and 2 months.
• Conventional loading as those dental implants loaded after 2 months.

Many factors needed to be considered by the cosmetic dentist when contemplating immediate dental implant placement including:

• Smile line
• Tooth position
• Soft tissue biotype
• Bone quantity and quality
• Presence of acute infection
• Patient's expectation

All of the above are crucial factors that can affect the decision to proceed with immediate dental implant placement.

The patient had high smile line with thin gingival biotype. She had high expectations. However, the tooth was fractured for few months and she did not mind to wait the treatment time with "no tooth" providing the final result can be guaranteed to be to the highest standards.

The treatment commenced with atraumatic tooth extraction (Fig 3).

At the time of tooth extraction, careful probing was undertaken of the socket. This provided direct mapping of the local anatomy and allowed assessing the thickness of the present bony plates. In addition, the tooth dimensions were measured and recorded (Fig 4). All of the above helped in choosing the dental implant size.

The extraction site allowed to heal for one month before dental implant placement. Dentsply, Xive® dental implant system was used in this case.

Following 4 months of healing, a temporary crown was placed to help developing the emergence profile of the final restoration (Fig 5).

Teeth whitening procedure was provided prior to recording the final impression. It is crucial that teeth whitening is provided at least 2 weeks prior to final shade recording for cosmetic dentistry, cosmetic veneers or dental implants. The final impression was recorded using dental implant level impression technique. An impression of the temporary restoration was recorded and sent to the dental laboratory.

AuraBase® abutment was chosen. This is similar to UCLA style abutment. The technician was asked to use porcelain down to the implant level (Fig 6). This is to improve on the colour emergence.

The final restoration was screw retained crown. The patient occlusion was assessed to make sure no interference was present (Fig 7). The patient was delighted with the outcome.