Odontologia

IJOICR CASE SERIES
Immediate Implantation and Prosthetic Rehabilitation

Immediate Implantation and Prosthetic Rehabilitation
Porus S Turner, 2Ferzin D Vazifdar, 3Ashdin P Turner, 4Danesh R Vazifdar, 5Rashnavi K Masalawala, 6Bilquis J Ghadiali, 7Cyrus S Karkaria, 8Radhika B Parekh
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Professor, Department of Prosthodontics, Mumbai, Maharashtra, India Turner’s Speciality Dental Center,Mumbai, Maharashtra, India Turner’s Dental Care Center, Mumbai, Maharashtra, India Ameretat Dental Labs, Mumbai, Maharashtra, India

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Correspondence: Porus S Turner, Professor, Department of Prosthodontics, AB Shetty Institute of Dental Sciences, Mangalore Karnataka, India, e-mail: porusturner@hotmail.com

Abstract Extraction and immediate implantation has become a veryreliable and time saving method of prosthetic rehabilitation of a patient. Achieving high primary stability and preservation of hard and soft tissues is of great importance with this treatment modality. Therefore using implant system which addresses these concerns would be important. The presenter with his vast experience with oral implantology will highlight his own method of atraumatic extraction,implantation and immediate provisionalization with nonfunctional loading, with the help of clinically treated cases. He will demonstrate his method which may have universal acceptance. Keywords: Immediate implant placement, optimum primary stability, nonfunctional loading, provisional restoration.

Implant placement immediately after extraction followed by an immediate provisional restoration can bea very rewarding way to provide implant therapy to our patients. It provides significant benefit both to the patient and the dentist compared with traditional delayed protocol of waiting for 6 months. It results in an improved preservation of the soft tissue drape and the bone architecture compared with their collapse after tooth extraction. In selected situations, it can even result in avoidanceof bone augmentation and soft tissue grafts. The procedure also reduces the number of surgeries which may be beneficial both to the dentist and the patient (Table 1). Factors critical to success include good initial implant primary stability in good quality bone. It is generally avoided when the labial plate of bone is missing and grafting is required. However, immediate implant placement andloading is technically challenging and should only be undertaken by clinicians with considerable experience with implant dentistry, both surgically and prosthetically.
Table 1: Advantages of immediate implant placement into extraction sockets and provisional restorations • Immediate esthetics by a fixed restoration • Prevents collapse of the peri-implant soft tissue through support given by acarefully crafted provisional restoration • Reduces the number of surgeries • Reduces time required for rehabilitation.

CRESTAL BONE LOSS AND THE BIOLOGIC WIDTH Preservation of crestal bone after 2 stage implant placement has been a concern. Because of the importance of bone to esthetics, the postoperative reduction of crestal bone after 2 stage implant therapy needs to be addressed. Crestal boneloss results in recession of the gingival margins and sometimes the papilla, particularly in individuals with thin biotypes. The manner in which the junctional epithelium and connective tissue attaches to the tooth and to the implant differ. Whilst the junctional epithelium attaches by way of glycoproteins to the natural dentition, a pseudo attachment through hemidesmosomes exists around endosseousimplants. In addition, connective tissue fibers mechanically insert into natural root cementum whereas in the case of implants, a tight cuff of connective tissue is formed around the titanium implant.1 Gargiulo2 documented a biologic width from the base of the gingival sulcus to the crest of the alveolar bone to be 2.04 mm, with epithelial attachment of 0.97 mm and connective tissue attachment of...