Clinical cas
The challenge of the surgical approach in the rehabilitation of an anterior sector unitary implant in a case of high aesthetic requirements; case report
Objective: Provide a detailed description of the current evidence-based clinical approach to a post-extraction implant with immediate loading and provisionalisation.
Clinical case: A 32-year-old female patient who attended for a possible root fracture of the upper left central incisor (ULCI), accompanied by a periodontal abscess at the bottom of the vestibule of the same tooth. A clinical and radiological examination established that the prognosis of the ULCI was unfavourable for conservative treatment. After evaluating the clinical features of the case, the treatment plan to extract the ULCI followed immediately by an osseointegrated implant (OII) and loading of a provisional prosthesis on the implant.
Conclusions: Rehabilitation on implants in situations of tooth loss in the aesthetic anterior sector, especially in young patients, requires a multidisciplinary treatment plan to extract the tooth and insert an OII in the correct 3-dimensional position. Various aspects need to be taken into account for this, particularly the residual remaining bone, the position of the gingival margin and preservation and conditioning of the peri-implant hard and soft tissues by means of grafts and proper handling of provisional prosthesis, until an ideal emergence profile and gingival contour is achieved before the final crown.
Oral biology has become more important in the 21st century, since it is necessary to highlight the processes related to bone and soft tissue biology, the loss of a tooth and the future of tissues after their replacement with a dental implant.
The physiological processes that take place after the extraction of a tooth are drastic, as they entail a series of modifications in the soft and hard tissues of the alveolar complex. Mainly, the microvascularisation of the architecture that surrounds the tooth suffers damage and atrophy that culminates in a decrease in the vascular supply provided by the periodontal ligament1-4. This results in a series of resorption processes discussed in this description of a clinical case.
Advances in oral implantology have brought with it new surface treatments for osseointegrated implants (OII), as well as different macroscopic designs and materials. This has been associated with greater primary stability of the OII and a better prognosis. The current trend in the field of implantology has been an evolution from conventional loading of the OII to immediate loading, due to the greater functional and aesthetic demands of society and patients5.
The benefits of immediate loading include a marked reduction in surgical interventions, less temporary dilation of the treatment and even better psychological and social wellbeing for the patient. In cases with a significant aesthetic requirement, immediate loading or provisionalisation, and post-extraction placement of the OII minimise alterations due to tooth loss and maintain the emergence profile, soft tissue contour and gingival papillae5-7.
Different protocols have also been established for the management of the anterosuperior aesthetic sector, in addition to performing the immediate implant and provisional crown, including placing material between the OII and the buccal cortical to minimise possible collapse and the management of peri-implant soft tissue8-11.
The objective of this article is to provide a detailed, evidence-based description of the clinical approach to a post-extraction implant with immediate loading and provisionalisation.
