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The Examiner

Online Edition
August, 2010
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Featured Article
Case Study
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Wade A. Diab, DDS, MS
3900 Frey Road, # 102
Kennesaw, GA 30144
770-426-1062
 
Greetings!
portrait5
In an effort to continuously update you and your staff on the latest trends in dentistry, I present to you the summer issue of the Examiner Online.  Knowing what your periodontist can offer your practice could greatly help you in making treatment decisions that would give your patients the comfortable, functional and esthetic dentition they always deserve. I hope you find this publication helpful and please do not hesitate to contact me with any question.  Your input is greatly appreciated.
 
Thank you,
Wade A. Diab, DDS, MS

Single Tooth Implant in the Esthetic Zone

A single tooth restoration in the anterior maxilla is the most challenging restorative procedure in dentistry.  The challenge is significantly compounded when the restoration is an implant supported crown. Although osseointegration is a very predictable event, placing and restoring an implant that meets the criteria of esthetic success is the most complex implant procedure for the surgeon and the restorative dentist. The trend of immediately placing implants in the anterior maxilla after extractions have proved successful.  Kemppainen et al. (1) reported a 99% success rate using one and two stage implants. Other studies have recommended one stage implants and immediate load with success in specific situations(2).  In my practice, I have been placing provisional restorations on implants at the time of insertion for several years.  Most of the implants that I placed following that protocol were in the lateral and central positions, however, implants in the upper and lower bicuspid regions were also successfully provisionalized at the time of surgery. Making and placing the immediate provisional restoration in my office allows me to properly control the soft tissue drape and ensure a successful final restoration.
Case Study
A 39 year old female patient was referred to my office for the extraction of tooth #9 and replacement with a dental implant.  The tooth was deemed non-restorable due to a fractured crown to subgingival levels.  The clinical evaluation revealed probing depth of 5 mm on the distal lingual of tooth # 9.  Radiographic evaluation revealed moderate bone loss on the distal of tooth # 9 associated with the fracture line on the distal lingual, however; adequate bone width and height for the placement of a dental implant is present.  No evidence of an acute lesion was noted and the patient was considered a good candidate for an immediate implant and immediate loading with a provisional abutment and restoration. 
 
Tooth # 9 was extracted using bone preservation technique and a Straumann 4.1 x 14 Regular Colar Bone Level implant was placed.  A provisional abutment and a provisional restoration were placed at the time of the surgery.  The provisional crown was out of occlusion and the patient was instructed to avoid biting on that area for eight weeks. The patient returned to the restorative dentist after three months for the final restoration.  The implant was restored with a zirconium abutment and a full porcelain crown.
 
 

preop

Above: Pre-op Picture of Tooth # 9.  The tooth had previous endodontic treatment and a fractured crown at the gingival level  
 
 

pre-op x-ray

Above: Pre-op Radiograph. Bone loss is noted on the distal of # 9 associated with the fracture line.  
   
 
     tooth   Implant post op x-ray
 
 
Above:  Tooth # 9 was extracted and an implant was placed immediately in the extraction socket.  A Straumann 4.1 x 14 Regular Collar Bone Level implant was placed.
 

 
 
Temporary1  Temporary2     
Above: An immediate provisional abutment and crown were placed
at time of extraction and implant placement
 
 

8 weeks

    
Above: Three months post-op.  Note the tissue color and contour around the provisional crown.
 
 

Final restoration

    
Above: Zirconium abutment and final porcelain crown delivered.  Note the absence of the common gray shadow around the implant due to the use of tooth colored zirconium abutment.
 
Acknowledgement
Restorative work performed by Dr. Ashish C. Patel, founder and owner of Dentistry at East Piedmont in Marietta, Georgia.
 
Restorative photographs courtesy of Dr. Ashish Patel.
 
 2009. Wade A. Diab, DDS, MS
 
Wade A. Diab, DDS, MS
Diplomate, The American Board of Periodontology 
Implants & Periodontal Artistry
3900 Frey Road, Suite 102
Kennesaw, GA 30144
P 770-426-1062
F 770-426-6789
 
 

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References
1.  Kemppainen P, Eskola S. Ylipaavalniemi A: Comparative prospective clinical study of two single tooth implants: a preliminary report of 102 implants, J Prosthet Dent 77:382-387, 1997.
 
2.  Groisman M, Frossard WM, Ferreira H et al: Single tooth implants in the maxillary incisor region with immediate provisionalization: 2 year prospective study, Pract Proced Aesth Dent 15:115-112, 2003.