Guided Immediate Placement of a Ceramic Implant in a Maxillary Right Second Premolar and Immediate Restoration with a CAD/CAM-Fabricated Provisional Crown
With this case, André Chen highlights the importance of the correct 3D positioning of monotype ceramic implants placed immediately in a single-tooth situation. One-piece implants have biological advantages but placing them in the correct prosthodontic position can be a challenge.
Every tooth extraction initiates a cascade of continuous events that lead to hard and soft tissue volumetric and linear changes (Araújo and coworkers 2019; Grunder 2011).
In recent years, implant dentistry has aimed to understand the biology of alveolar socket/bone remodeling in order to minimize the impact on linear and volumetric parameters, with lower morbidity and fewer esthetic problems (Atieh and coworkers 2015).
Surgical classification
Complex
Prosthodontic classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 14
CME/CPD
0.25 hours
Purchase price
10
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General Risk Assessment
Patient-related Factors
| Oral hygiene | Good |
|---|---|
| Compliance | Good |
Patient-medical Factors
| Medical Fitness | Healthy, able to undergo planned anesthesia and surgical procedure (ASA I) |
|---|---|
| Medications | No medications that would negatively affect the surgical procedure and outcomes. |
| Radiation Treatment | None |
| Growth Status | Complete |
Site-related Factors
| Periodontal Status | No history of periodontal disease, or any active periodontal disease. |
|---|---|
| Access | Adequate |
| Pathology near the implant site | None |
| Previous surgeries in planned implant site | No previous procedures. |
Surgical Classification
Surgical Complexity
| Timing of placement | Immediate Placement (extraction sockets) (Type I) |
|---|---|
| Simultaneous or Staged grafting procedures | Implant placement without adjunctive procedures |
Anatomy
| Keratinized Tissue | Sufficient (>4 mm) |
|---|---|
| Soft Tissue Quality | No scars or inflammation |
| Proximity to vital anatomic structures | Minimal risk of involvement |
Adjacent Teeth
| Papilla | Complete |
|---|---|
| Recession | Absent |
| Interproximal attachment | At CEJ |
Extractions
| Radicular morphology | Uniradicular |
|---|---|
| Available apical bone to achieve primary stability | Sufficient height ( ≥ 4 mm) and width (> 2 mm around apex of planned implant) |
| Socket walls | Intact |
| Thickness of buccal wall | 2mm or greater |
| Anticipated residual defect after implant placement | 2 mm or less |
Prosthodontic Classification
Complicating Factors
| Biological | Cement-retained restorations with appropriate contours |
|---|---|
| Mechanical/Technical | Absence of contributing factors |
Prosthesis Factors
| Prosthetic volume | Adequate. Space available for ideal anatomy of the restoration |
|---|---|
| Inter-occlusal space | Adequate. Capable to create an anatomically & functionally correct planned restoration |
| Volume and characteristics of the edentulous ridge (fixed) | Adequate. No adjunctive therapy or prosthetic soft tissue replacement will be necessary |
Occlusal Factors
| Occlusal scheme | User-defined occlusal scheme achievable |
|---|---|
| Involvement in occlusion | Minimal or no involvement |
| Occlusal parafunction | Absent |
Complexity
| Loading Protocol | Immediate |
|---|---|
| Implant-supported provisional restoration | Required, non-esthetic site and/or functional demands |
| Timing of placement | Immediate Placement (extraction sockets) (Type I) |
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