|Year : 2017 | Volume
| Issue : 5 | Page : 39-43
Immediate loading with single-piece implant following extraction
Hemlata Dwivedi1, Rita Jain2
1 Department of Prosthodontics, Dental College Azamgarh, Azamgarh, Uttar Pradesh, India
2 Department of Prosthodontics, GIDSR Dental College and Hospital, Ferozepur, Punjab, India
|Date of Web Publication||15-Sep-2017|
Department of Prosthodontics, Flat No. 1, Staff Quarter, Dental College, Itaura, Azamgarh, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Although dental implantology had evolved over a number of years, many dental surgeons are unaware of the concept of immediate loading with the use of one-piece implant that began in the early 1960s. The goal of successful prosthodontics rehabilitation is to provide function, esthetics, and comfort to the patient. The aim of this literature is to provide an overview of one-piece implant, with its advantages and disadvantages over conventional two-piece implant. Immediate prosthetic of a one-piece system allows for a better tissue healing and better adhesion of gingival mucosa to form a collar which is healthy and adherent to the implant, avoiding a second surgical procedure, and also includes a very important aspect esthetics. This article describes a case report of immediate loading with single-piece implant following extraction.
Keywords: Dental implant, immediate loading, provisional restoration
|How to cite this article:|
Dwivedi H, Jain R. Immediate loading with single-piece implant following extraction. Indian J Dent Sci 2017;9, Suppl S1:39-43
|How to cite this URL:|
Dwivedi H, Jain R. Immediate loading with single-piece implant following extraction. Indian J Dent Sci [serial online] 2017 [cited 2019 Oct 20];9, Suppl S1:39-43. Available from: http://www.ijds.in/text.asp?2017/9/5/39/214936
| Introduction|| |
As skin is the best dressing for the wound, tooth is the best stimulant for the jaw, and in its absence, it is the dental implant.
In the early years of modern implantology, the chief concern was tissue health and implant survival. However, over the past decade, there has been an increasing realization that esthetics is just as important to the success of the final restoration as health. Patients increasingly demand restorations that are as esthetic as they are functional. Implant placement and restoration to replace single or multiple teeth in the esthetic zone is a challenge to the clinician. It is indeed a technique-sensitive procedure with little room for error. Preservation or creation of a soft-tissue scaffold to create the illusion of a natural tooth is challenging and difficult to achieve.
Single-tooth replacements will most likely comprise a larger percentage of prosthetic dentistry in the future compared with past generations. Contrary to missing a posterior tooth, most patients have an emotional response regarding an anterior missing tooth. No question exists regarding the need to replace the tooth, and financial considerations are less important. When a posterior tooth is extracted, the preparation of the adjacent tooth may be given to the dentist. However, when an anterior normal-looking tooth is to be prepared to serve as fixed partial denture (FPD) abutment, the patient is more anxious and often looks for an alternative. In the patient, prospective anterior FPD restorations are never esthetic as natural teeth. As these patients are only able to notice the restorations that are not natural in appearance, they think anterior FPDs are not esthetic.
Anterior tooth replacement is one of the most challenging restorations in dentistry. However, in light of all advantages of single-implant longevity, bone maintenance, reduced abutment teeth complications, and increased adjacent teeth survival, single implants have become the treatment of choice. Immediate postextraction implant placement based on proper examination and diagnosis would reduce patient burden.
Single-tooth implant has the highest success rate compared with any other treatment options to replace missing teeth with an implant restoration (overdentures, short-span FPD, and full-arch FPD).
More recently, a trend toward single-stage and immediate extraction implants has emerged, appearing especially attractive in the anterior region, where soft-tissue drape is present before the tooth extraction and the patients are more anxious to get a fixed replacement.
| Case Report|| |
An 18-year-old female patient reported to the Department of Prosthetic Dentistry with a chief complaint of mobile lower incisor. Past dental history revealed that the patient had missing #31 and #41 and a mobile deciduous incisor present. Past medical history was noncontributory. Extraoral clinical examination revealed adequate mouth opening and no signs and symptoms of temporomandibular joint dysfunction; the path and range of mandibular movements were normal and the smiling lip line was normal. There was intraoral Class I molar relation with bilateral canine-guided occlusion. The patient had missing tooth #31, #41. Examination of the implant site revealed normal healthy gingiva and adequate band of attached gingiva, and adjacent teeth were vital, normal in color and appearance, and free of any pathological mobility with normal probing depth [Figure 1]. Orthopantomography (OPG) used for primary screening revealed no pathology in the jaw [Figure 2]. Oral hygiene was acceptable.
To restore the missing incisors, the following prosthetic treatment options were explained to the patient along with their pros and cons – implant-supported prosthesis, removable partial denture, and conventional FPD. The patient opted for implant-supported fixed prosthesis.
Available vertical bone height was >20 mm (from OPG). Selected implant length = 13 mm
Available mesiodistal space:
- As per intraoral periapical (IOPA) radiograph = 6.5 mm
- As per cast = 5.5 mm
- As per OPG = 7 mm.
As estimated by ridge mapping, the buccolingual width was 4.5 mm, 4 mm from the ridge crest [Figure 3]. Hence, based on evaluation of clinical and radiological data, an implant of following dimensions was selected for the case: length = 13 mm, diameter = 2.4 mm, and the abutment was planned to emerge from the incisal edge of the proposed crown and a surgical guide was fabricated along that proposed angulation in clear acrylic [Figure 4].
Surgical protocol emphasized complete asepsis and infection control. Amoxicillin 1 g for 1 h before surgery then 500 mg for 3 times daily for the next 3 days. Before the surgical procedure, the patient was instructed to rinse with 0.2% chlorhexidine gluconate for 1 min. A papillae sparing incision (parapapillary incision) was used to preserve blood supply to the delicate interdental papillae and to minimize the potential of postsurgical gingival recession. A full-thickness mucoperiosteal flap was raised buccally and lingually to the level of mucogingival junction exposing the underlined ridge of the implant site, and a ridge alveoloplasty was performed with the help of 0.2 mm round bur to achieve a flat bone surface of sufficient width [Figure 5]. A surgical drill guide was used for the precise placement of the pilot drill [Figure 6]. After pilot drill, the implant site was prepared with the corresponding size of the parallel drill. A paralleling tool was inserted to check the parallelism with the adjacent teeth [Figure 7]. The implants were placed by means of an insertion device and a torque driver set at 35 Ncm. The implant neck was positioned at the crestal bone level or slightly submerged [Figure 8].
Prosthetic replacement – temporary
After surgical intervention, the prefabricated temporary crown with acrylic resin was trimmed, polished, and cemented on the implant [Figure 9]. Compared to the natural tooth, the temporary restoration was kept without any contacts in functional occlusion. Depending on the gingival thickness, the crown margin was placed 0.5–1 mm below the gingiva. The flap was replaced in its original position and sutured with nonresorbable suture (4-0) [Figure 10]. IOPA radiograph was taken immediately after surgery [Figure 11]. The patient was recalled after 24 h. Sutures were removed after 1 week. The patient was recalled after 3 months to check implant integration and oral hygiene.
Prosthetic reconstruction – permanent
After 3 months, the definitive restoration was fabricated with a metal ceramic crown. The morphology of the metal ceramic crown was similar to that of natural tooth with incisal contact in maximum intercuspation. The premature contacts during lateral and protrusive movements were avoided. The crown was cemented [Figure 12], and a follow-up of implant survival was done up to 1 year.
| Discussion|| |
Several long-term studies on single-tooth replacement have shown excellent results over a 5-year period. To achieve bone-to-implant contact (osseointegration), oral implants placed according to a two-stage surgical protocol have been advocated to remain unloaded for a healing period of 3–6 months. A reanalysis of this original experimental design has questioned the necessity for a long implant healing period. The current scientific literature supports the concepts that the implants can be loaded early or immediately.
Studies regarding different types of prosthesis have shown that early loading of mandibular implants can provide treatment outcomes comparable to those achieved using standard healing periods before loading.
The advantages of nonfunctional immediate teeth are as follows:
- Patient has a fixed esthetic tooth replacement soon after Stage 1 surgery
- No Stage 2 surgery is necessary (eliminates discomfort for the patient and decreases overhead for the doctor)
- Countersinking the implant below the crestal bone is eliminated, which reduces early crestal bone loss
- The soft-tissue emergence may be developed with the transitional prosthesis and the tissue was allowed to mature during the bone healing process
- The soft-tissue hemidesmosome attachment on the implant body below the microgap connection may heal with improved interface.
The disadvantages of nonfunctional immediate teeth are as follows:
- Micromovement of implant that can cause crestal bone loss or implant failure is greater than that with two-stage surgery
- The dentist is less likely to reflect the tissue at Stage 2 surgery and can evaluate implant crestal bone directly
- Parafunction from tongue or foreign habits (pen biting) may cause trauma and crestal bone loss or implant failure
- Bone that is too soft, small implant diameters, or implant designs with less surface area may cause crestal stress contours and cause bone loss or implant failure.
| Conclusion|| |
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 esthetic 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.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]