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Immediate Implant Placement with Static Computer-Aided Implant Surgery and Immediate Loading in the Esthetic Zone with Prefabricated CAD/CAM Provisional Implant Restorations

This case from Alejandro Lanis, Luiz Henrique Gonzaga, and Adam Hamilton demonstrates how s-CAIS accurately transfers the virtual treatment plan to the surgical site. In cases where immediacy is indicated, s-CAIS is considered the gold standard to obtain a precise and adequate 3D implant position.

The type 1A protocol for immediate implant placement and immediate loading is defined as a surgical and prosthodontic procedure where dental implants are placed in the extraction socket on the same day the tooth is extracted and a restoration is delivered immediately (Morton and coworkers 2018; Gallucci and coworkers 2018). In the esthetic zone, the success of this approach depends on several factors, such as an adequate diagnosis, appropriate patient selection, favorable alveolar anatomy, suitable conditions at and characteristics of the surgical site, and proper training and sufficient experience on the part of the clinician (Levine and coworkers 2017; Chappuis and coworkers 2013; Belser and coworkers 2009; Chen and Buser 2014).

Surgical classification
Complex
Prosthodontic classification
Complex
Learner Level
Source
Treatment Guide 14
CME/CPD
0.25 hours
Purchase price
10
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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
Number of implants Two - Three

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
Planned contour of tissue-fitting surfaces Appropriate contours (hygienic - accessible for maintenance)

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 High
Shape of tooth crowns Rectangular
Restorative status of neighboring teeth Virgin
Gingival Phenotype Low-scalloped, thick
Bone level on adjacent teeth ≤5 mm to contact point

Occlusal Factors

Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involved with guidance
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 High
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 mm to contact point
Thickness of buccal wall 2mm or greater
Patient's Expectations High but achievable
Publication date: Oct 27, 2023 Last review date: Oct 20, 2023 Next review date: Oct 20, 2026
3 - Proficient to Expert Clinical Case Treatment Guide 14

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