Situation
Introduction
1. There are four different treatment options for post-extraction implant placement. 2. In anterior area, esthetic complication is one of the most common problems especially in thin gingival biotype. 3. Immediate implant placement is not recommend when the anatomical conditions are not ideal. 4. Early placement has been proposed to overcome the esthetic complication in patients at risk. 48 year old female presented to have dental implants on her maxillary anterior tooth and mandibular posterior teeth. - PMH : Non-contributory - No known drug allergy - PDH : Crown on the tooth #21,#26,#44 - Root canal therapy on the #21,#26 - Missing teeth #37,#45,#46,#47
Treatment Plan
1. Scaling and root planning
2. Extraction of the tooth #24, 25, 26, 27, 37 and 38
3. Root canal therapy and Crown fabrication of the tooth #36
4. Implant placement of #24,25 and 26 at 2 month after extraction with simultaneous guided bone regeneration
5. Uncovering at 4 months after the implant placement
6. Final prosthesis
Facial view, gingival recession and super eruption on the tooth #21
Thin gingival biotype was observed.
Pre-op CT Scan
Extraction of the tooth #21
#45,46 implant placement
1.5 month of healing after extraction of the tooth #21
CT scan after soft tissue healing of the tooth #21
#21 Implant placement
IS II active 4.0*10 was placed under local anesthesia. Primary stability was achieved. Note buccal dehiscence after implant placement.
Allogenic bone graft (ICB cortical) was performed and covered with resorbable Collagen membrane.
Flaps were sutured by 5-0 Nylon
Uncovering of the tooth #45,46
Final prosthesis of the tooth #45,46
Healing after 4 month of #21 implant placement
Facial bone regeneration was observed.
Connective tissue graft was inserted on the facial of side of the implant
Uncovering of the tooth #21
2 weeks follow up after uncovering of the tooth #21
3 weeks after uncovering of #21
Amalgam pigmentation was removed utilizing #15 blade
Periacryl was applied (no suture)
Provisional restoration
Abutment connection
Final prosthesis, facial gingival recession was restored.
Final prosthesis, panoramic X-ray
Final prosthesis, occlusal photo
Post-op 1.5 year, stable facial gingival margin
Conclusion
1. Neobiotech implant can be successfully placed and restored in both anterior and posterior area.
2. Early implant placement with simultaneous bone graft can be utilized when anatomical condition is not ideal (thin biotype, recession, chronic infection)
3. Successful outcome was achieved when placed both early and delayed timeframe with Neobiotech IS II active implant