Dentaltown January 2016 - (Page 78)

prosthodontics feature Saving Her Smile by Panos Papaspyridakos, DDS, MS, PhD and Michael Vizirakis, DDS, MS Immediate Implant Placement and Fixed Provisionalization with Extracted Tooth Introduction Following tooth extraction, the alveolar ridge undergoes dimensional alterations.1 However, the fate of the buccal bone wall cannot be predicted easily and studies have demonstrated that extensive resorption of even intact buccal plates is a common phenomenon after extraction.2 A recent cone-beam computed tomography (CBCT) study on the thickness of buccal bone of maxillary central incisors showed that there is a prevalence of thin facial bone with less than 1mm thickness for most anterior maxillary incisors.3 Another recent CBCT study on the thickness of facial bone for all six anterior maxillary teeth corroborated these fi ndings.4 It was found that almost 50 percent of teeth in the anterior maxilla have less than 0.5mm thickness of buccal plate. These findings were corroborated by another CBCT study that showed that the facial bone wall thickness was very thin or missing in approximately 90 percent of the 125 patients under investigation.5 78 JANUARY 2016 // dentaltown.com Immediate implant placement, with or without simultaneous implant provisionalization, has gained popularity due to the shortening of treatment time and reduction of surgical interventions. Successful outcomes have been reported with immediate provisionalization of implants placed in fresh extraction sockets, especially in regard to interproximal papilla.6-13 On the other hand, midfacial recession is the most commonly encountered complication with this treatment approach.14, 15 Case selection and accurate 3D implant positioning are of utmost importance, since there is a high risk for esthetic failures. When part of the buccal bone is missing following extraction, early implant placement after a healing time of six to eight weeks has been suggested.16-18 The implant installation is performed with simultaneous guided bone regeneration (GBR) to restore facial contour. A submerged approach is performed, followed by removable provisionalization during the osseointegration period. The long-term results of this contour augmentation have been encouraging clinically and esthetically after five to nine years of follow-up.18 The quality of the facial soft tissues and implant-prosthetic outcomes were satisfactory after application of pink (PES) and white esthetic scores (WES). The key to an esthetically pleasing appearance lies in the clinician's ability to properly manage the soft-tissue profi le around dental implants. Hence, the objective of this clinical report is to illustrate the outcomes of immediate implant placement after an atraumatic extraction of a fractured tooth and the immediate fi xed provisionalization with the same extracted tooth, followed by the defi nitive restoration and one-year clinical follow-up. Case history The patient, a healthy 55-year-old Caucasian female, presented to the practice with a chief complaint of, "My front http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown January 2016

On Dentaltown.com
HOWARD SPEAKS: What Do You Need in 2016? Another Operatory
PROFESSIONAL COURTESY: The Next Generation of Dentists
Continuing Education Update
Mom Wants to Sit in the Hallway So She Can Hear What We’re Doing to Her Child
Why You Should Never Let Patients Talk You Out of Periodontal Plastic Surgery Before Esthetic Treatment
Chasing Pain: Diagnosing and Treating Trigeminal Neuralgia in General Dentistry
Chasing Sheep: The Four Pillars of Treating the Sleep-Disordered Patient
Product Profi le: Family Dental Marketing
Implementing Orthodontics in Your General Practice
Endodontic Advancements: How Leading Technologies Help Transform Endodontic Treatment Options
The Power of Piezo: A Predictable and Painless Approach
Veneers: Utilizing Silicon Matrices to Optimize Ideal Preparation Design
Improve Your Patients’ Lives Through Pro-Bono Referrals
Progressive Smile Design: Changing the Shape of Cosmetic Dentistry
The Ultimate Handover in Your Dental Office
Meet the New Intraoral Sensor
Poll
Want to Compete with Big Business? Tap Into Your Relationships
Saving Her Smile: Immediate Implant Placement and Fixed Provisionalization with Extracted Tooth
TOWNIE MEETING 2016 Preview
Ad Index
The Heart of the Hygienist: Dental Hygiene’s Role in Public Health
What to Do With Patients Who Refuse SRP and Only Want a Cleaning
CONTINUING EDUCATION: Indirect Posterior Composite Restorations
Dentally Incorrect

Dentaltown January 2016