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Immediate placement and immediate loading of an onebody implant in the anterior mandible

Situation


Preoperative Observation


- Missing tooth on #31

- Apical lesion on #41

- Advanced periodontitis on #42


Treatment Planning

- Implant supported single crown on #31 and #42

- Endodontic treatment on #41

- Crowns on #32 and #41

 

Site #31 following the old bridge removal seemed to have enough bone and soft tissue.

Extraction socket #42 and bone defect on the buccal side of #31.


Site #31 was drilled using a Ф1.5mm drill in the S-mini kit. The labial side was exposed and in need of bone graft.

A Φ2x11.5mm S-mini onebody implant was being placed.

35Ncm of insertion torque was achieved.

An allograft material (RegenOss) was packed on the labial defect, then a collagen membrane was placed over the graft. A Φ2.5mm S-mini implant was placed in the socket #42 with flapless surgery and graft.


The graft area was secured with sutures.

Additional bone materials were inserted into the defect.

Radiograph taken after the surgery.

The implant was immediately loaded with an acrylic resin provisional restoration.


The final impression was taken using impression caps # weeks after the surgery. By using an impression cap, a shape of subgingival post can be taken without gingicord insertion.

An impression taken with impression caps.

2 modified lab analogs were repositioned by placing them in the stone poured analog bed.

Original analogs (left) and modified analogs (right).

Modified ones are applicable on impression with slight resistance.

Stone dies fabricated with stone abutments.

The final restoration delivered 4 months after the surgery.

Radiological 4 months follow-up.

Facial view of the patient's smile 3 months after the surgery.

3 years follow-up. No further bone loss was found.

Clinical view of four mandibular anterior teeth.


 

Conclusion


Esthetic embrasure is hard to get in the mandibular anterior region with a 2-staged implant (top). This case shows surgical to prosthetic procedures of onebody implant placement and immediate loading on #31 and #42 (bottom).

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