Immediate implant placement with 4.5 years follow up (Legacy 1 dental implant)

The case presented is an extraction with immediate implant placement of an upper right first premolar. Patient has been followed up for 4.5 years. Radiographic evidence of inter-proximal bone stability has been consistent through out the years.

In our clinical practice, we have found true that with the proper prosthetic management of soft tissues, adequate quality and quantity of hard tissues and appropriate periodontal maintenance, we could expect long term hard and soft tissue stability, even in periodontally controlled patients.

Key points of the techniques used:

Surgical
- Maintain facial wall intact
- Disinfection of the socket thoroughly
- Surgical removal of the coronal portion of the inter-radicular septum to get a more stable grip of the initial drill in the socket
- Extend 3mm apically to the existing socket to obtain adequate primary stability (therefore, extra 3mm of bone apical to the existing socket)
- Place your implant towards the palatal socket allowing at least a 4mm space between the facial wall to the implant platform and fill in the gap with bone graft material
.
Prosthetics
- Screw retained restorations to prevent the retention of cement apically towards the implant body where it would be harder able to detect.
- Torque crown to 30N/cm or as per manufacturer's recommendation to minimize microgap and micro movement
- Protected occlusion

Implant uncovery technique to correct facial soft tissue deficiency

The case presented is a 2 stage immediate dental implant placement.

Upon implant uncovery,  the top of the implant (cover screw) was covered by bone which was then removed.

The facial soft tissue presented an evident clinical deficiency. In similar cases when this type of tissue deficiencies are not corrected, this can lead to a less than acceptable esthetic result of the area restored.

We utilized a technique that we feel comfortable with to restore this type of deficiencies, in which we augment the facial soft tissue thickness at the time of implant uncover.

Steps:
1. De-epithelialize the crestal portion of the soft tissue (exposing CT)
2. Elevate a mini flap (with 2 small vertical incisions)
3. Split the CT from the mini flap without separating each other
4. Create a facial pouch with split thickness flap
5. Rotate the CT into the facial pouch
6. Place the healing abutment
7. Suture the flap into position

Materials used:
- Implant: Legacy 3 (Implant Direct)
- Sutures: Gut 4.0

Best,
Ioannis 

Legacy 3 Implant restoration

The patient is controlled diabetic with fair oral hygiene but stable periodontal attachment for the last 7 years (He is my father).
Due to diabetes we proceeded with staged approach for the implant placement.
Extraction+socket graft and later implant placement

The design of the prosthesis:

The lab fabricates a PFM crown keeping access to the screw of the abutment
The abutment is sandblasted and the crown is cemented on the abutment with a permanent cement extra orally

Benefits:
1. Cost ( you use the abutment that comes with the implant)
2. Factory abutment has better fit on implant platform compared to a UCLA abutment
3. Avoid cement trap in cases with deep peri-implant sulcus. This could lead to peri-implantitis development
4. Easy access in case the crown needs to be removed for any reason

Ioannis

Socket Graft of a Maxillary 1st Molar

Diagnosis
1. #16 Hopeless for endodontic and restorative reasons.
2. Odontogenic sinusitis

Treatment plan
Extraction of #16 and graft
3-4 months later
Dental implant placement with possible minor sinus lift

We utilized a cross type, double layer technique with a collagen membrane to over come major facial bone resorption.
Why?
Because the facial wall was very thin with small fenestration present. This kind of conditions might lead to up to 4mm bone resorption if GBR is not utilized at the time of extraction.
Upon re-entry the alveolar ridge width was 10.5 mm. This allows us to place a 5mm diameter implant with good amount of bone surrounding it.

Ioannis