Immediate replacement of a primary canine with an implant

Patient presented to our clinic for removal of a long standing primary upper right canine (#53) and to be replaced with a dental implant. Clinically, the tooth to be extracted presents with class 3 mobility. 

Patient is a mild smoker (<10 cig/day) without any other contributing factors in the medical history.

We proceeded with the extraction of the primary tooth. The socket was thoroughly derided and difinfected with diamond burs and rinsing with a mixture of TTC solution and saline. 

A Legacy3 3.7x11 implant was immediately placed following the appropriate position within the existent socket.  A high insertion torque was obtained. An impression was taken and a 2 stage protocol was utilized due to the smoking habit of the patient. 

Uncovery of the implant was performed 3 months later.  A temporary crown was placed at this time in order to guide soft tissue profile during healing. 

1 month later, a final screw retained crown was placed by the GP. 

At 1 year post-implant placement, soft and hard tissues seem favorable. However, patient's interproximal oral hygiene was fair and thus mild gingival inflammation is evident on the mesial papillae. 

Oral hygiene was reinforced and an appropiate maintenance schedule was discussed with the patient to ensure gingival health around the implant.

SOCKET GRAFT WITH CYTOPLAST MEMBRANE

Patient presented in our clinic for extraction of tooth # 36 and dental implant replacement after it was diagnosed non-restorable by the patient's dentist.

Treatment plan:

- Extraction of #36 and socket graft

- Dental implant placement 3-4 months later

- Restoration of the dental implant 2-3 months later.

Upon extraction and thorough disinfection of the socket, a facial dehiscence ranging from 8-11mm was identified. Also, a 4mm deep 4-wall defect was found on mesial of tooth #37.

The #36 socket and the periodontal defect on #37 were grafted with a mixture of FDBA and tetracycline and covered with a cytoplast membrane. The membrane was left exposed. Oral hygiene instructions to the patient involved chlorhexidine gel 0.2% application 3 times per day for 7 weeks until the membrane was removed.

A Legacy3 5.2x10mm dental implant was then placed 4 months later presenting high initial stability. After 1 year post-op, good bone stability around the implant can be observed. Also, the defect on medial of #37 responded favorably as it can be observed clinically and radiographically. 

The technique used in this particular case could be utilized in posterior sites with a thick soft tissue and where large amount of bone augmentation is required. Patients medical history should be clear so proper healing could be expected. It is not recommended for patients with potentially impaired healing like diabetics and smokers.