Immediate Implant Placement and Restoration of a Maxillary Left Central Incisor with a Provisional Crown
Leon Pariente and Karim Dada outline the Immediate Implant Placement and Restoration of a Maxillary Left Central Incisor with a Provisional Crown, demonstrating how the hard and soft tissue architecture can be maintained with a Type 1A treatment protocol and a fixed provisional, providing an esthetic and comfortable immediate solution.
A 34-year-old female patient with high esthetic expectations, a non-smoker with no relevant medical history (ASA class 1), was referred to the practice for replacement of her failing maxillary left central incisor (tooth 21), which exhibited a vertical root fracture as diagnosed by the referring endodontist under the microscope. This case illustrates a type 1A treatment protocol (Gallucci and coworkers 2018) complete with diagnosis, treatment decisions, and clinical and laboratory steps.
Surgical classification
Complex
Prosthodontic classification
Advanced
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 14
CME/CPD
0.25 hours
Purchase price
10
You must be logged in to access or purchase this item.
There is a wealth of resources you can access by signing up
as an ITI Member. Learn more about ITI membership benefits.
General Risk Assessment
Patient-related Factors
| Smoking Habit | None |
|---|---|
| Oral hygiene | Good |
| Compliance | Good |
| Patient's Expectations | High but achievable |
Patient-medical Factors
| Medical Status | Healthy, uneventful healing |
|---|---|
| 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 with simultaneous hard and soft tissue procedures |
Anatomy
| Bone Volume - Horizontal | Adequate |
|---|---|
| Bone Volume - Vertical | Adequate |
| 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 | Screw-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 |
Esthetic Factors
| Gingival display at full smile | Medium |
|---|---|
| Shape of tooth crowns | Rectangular |
| Restorative status of neighboring teeth | Virgin |
| Gingival Phenotype | Low-scalloped, thick |
| Bone level on adjacent teeth | 5.5 to 6.5 mm to contact point |
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, elevated esthetic and/or functional demands |
| Timing of placement | Immediate Placement (extraction sockets) (Type I) |
Esthetic Risk Assessment
Esthetic Risk Assessment
| Medical Status | Healthy, uneventful healing |
|---|---|
| Smoking Habit | None |
| Gingival display at full smile | Medium |
| Width of edentulous span | 1 tooth (≥ 7mm, standard diameter implant) 1 Tooth (≥ 6mm, narrow diameter implant) |
| Shape of tooth crowns | Rectangular |
| Restorative status of neighboring teeth | Virgin |
| Gingival Phenotype | Low-scalloped, thick |
| Infection at implant site | None |
| Bone level on adjacent teeth | 5.5 to 6.5 mm to contact point |
| Thickness of buccal wall | 2mm or greater |
| Patient's Expectations | High but achievable |
Share this page
Download the QR code with a link to this page and use it in your presentations or share it on social media.
Download QR code