Case report- Trans mucosal Implant
Clinic: Preet ViharThursday September 20th, 2018
Doctor Name: Brig (Dr.) S. K. Roy
Dental implants and immediate loading concept were evolved with time to fulfil aesthetic demand of the patient. A Transmucosal implant with immediate loading provides benefits like less pain, minimal inflammation and immediate cosmetic results. Immediate loading of one piece implants by using provisional acrylic resin crown with minimally invasive or atraumatic, flapless surgical procedures provides a better soft tissue adhesion and seal to form a healthy collar, avoids a second stage surgical procedure and with higher patient acceptance. One-piece implant also allows a minimally invasive trans-mucosal flapless placement and limits the requirement of hard tissue grafting procedures.
Case Report
A 36 year female patient reported to the clinic with the chief complains of missing tooth in her upper right side. History revealed the removal of retained deciduous tooth recently. Patient visited multiple clinics outside clove and she was advised 3 unit fixed prosthesis due to less space. Patient was not interested to go for 3 unit bridge as it involves significant reduction of adjacent vital teeth.
Figure 1 – Pre-operative picture showing Maxillary right side missing tooth
Figure 1 – Intra-oral clinical examination revealed sufficient space for an implant supported prosthesis
Figure 2 – IOPA showing limited space available for implant
Figure 2 – Radiographic evaluation (IOPA) showed less space apically due to divergence of adjacent teeth
Figure 3 – OPG showing
Figure 3 – OPG was taken and it was decided to place tapered one piece implant
Treatment plan was explained to the patient and informed consent was taken for the procedure. Immediate restoration was planned, therefore flapless approach was preferred.
Figure 4 – Osteotomy showing ideal angulation for implant placement
Figure 4 – Local anesthesia was given and pilot drill used for initial osteotomy
Figure 5, Figure 6, Figure 7 –
Radiographs were also taken after initial drill to confirm the angulation. A 3x10mm AB Dent I5 single piece tapered implant placed after sequential osteotomy
Figure 5 – 3x10mm AB Dent I5 single piece tapered implant
Figure 6 – Implant placement
Figure 7 – Implant placed. Right clinical picture and Left radiograph
Figure 8 – Flapless approach provided minimal bleeding and laceration at the surgical site. Abutment was round and shaped to receive immediate crown
Figure 9 – Immediate temporary crown
Figure 9 – Impression made using alginate impression material and models were poured. In-clinic temporary crown was fabricated on model using tooth coloured self cure resin. Immediate crown was cleaned using ultrasonic bath and placed in a sterile solution. Patient recalled and immediate crown was cemented on the milled abutment
Implant therapy is today widely regarded as a reliable treatment option to replace missing teeth; however, correct surgical placement of dental implant is mandatory to obtain the ideal aesthetic result. Only through proper treatment planning can the correct position and number of implants be determined. The clinician must consider the time needed for implant integration and soft-tissue healing, creation of emergence profile, occlusal forces in relationship to progressive loading, and occlusal forces on the final restoration. One piece implant design was originally created to eliminate the structural weakness built into the two-piece implant design (the microgap) but now it is widely practiced for the cases of high aesthetic demand.
The present treatment plan provided immediate aesthetic results with no trauma to the adjacent teeth. Immediate temporary crown was given on same day of surgery. Immediate temporary crown will be converted to the permanent ceramic crown after osseointegration.
Patient was very happy as her smile was restored immediately and improved her confidence in social life.
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