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
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