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Delayed Implant placement on periodontally compromised single anterior tooth


Brief History

- 55 years old female patient complaining on mobile and displaced upper left central incisor

- Patient is healthy without any medical problem or any know allergies

- Patient wishes to replace the compromised tooth #21 with an Implant

- Patient does not want any autogenous bone or soft tissue harvested


Treatment Plan

- Extraction with socket preservation to preserve hard tissue

- Delayed Implant placement with any tissue graft in necessary

- Long term provisional crown to remodel and re-establish gingiva zenith, interdental papilla and soft tissue contour

- Final prosthesis with customized abutment copying the profile of the established soft tissue support

 

Pre-operative



Atraumatic extraction and socket curratage



Collagen membrane placement



Pre-preparation



GBR with mixture of allograft and PRF




Closure of socket with pre membrane



Composite bonded bridges as provisional for 4 months



Healing after 4 months, good soft tissue


Pre-operative OPG : bone density poor

CBCT assessment : Bone graft poorly integrated



Incision and flap opening



Bone is soft with much granulation tissue



Implant placed slightly for higher primary stability


Insertion torque



GBR with xenograft


Tension free primary closure


Post-operative OPG




1 Month healing



4 Months healing



Changing Healing abutment


Provisional crown for 4 months



Final Impression



Final customized abutment with Titanium base for soft tissue adherence



Crown in place

Final OPG



Final smile



Before & After
























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