Immediate Placement
Teeth fracture for many reasons. When an anterior tooth has fractured, there are several options to consider. The traditional FPD has been done commonly done, but more and more patients are considering an implant restored crown for the obvious benefits of not prepping the sound adjacent teeth.
There are different ways that an anterior tooth can be replaced with an implant. One is to place an implant wait for the implant to integrate, then restore with a crown. Another way is to place an implant and then place a temporary crown right after the implant placement. What about a case like you see below? The lateral incisor has fractured at the gingival level. As you can see, an implant was placed immediately after extraction of the remaining root and the old PFM crown was used a temporary crown. By doing so, the patient had the same PFM crown when she walked out of the office. The soft tissue contour was preserved for the final restoration since the current PFM has almost the ideal shape of the lateral incisor. The patient did not have to go through multiple procedures of extracting the root rest, surgical placement of an implant and so on.
- Fractured #7
- Immediate placement after extraction. Against my desire, the papillae were severed by someone else who did the extraction.
- Immediately placed old PFM. The papillae were sutured. It is best to leave the papillae intact during extraction.
- Radiograph after implant placement. Arrow indicates the implant and abutment junction.
On the radiograph above, the implant is placed past the apical extent of the extraction socket to achieve a good initial stability. The immediate abutment sits on top of a Nobel Biocare Replace Select Tapered, 13 mm in length. The implant is placed about 3 mm apical to the CEJ of the adjacent teeth to ensure good emergence profile. The actual implant and immediate abutment junction (black arrow) is about 3 mm apical to the adjacent CEJ’s. The radiolucent area between the PFM and the wide section of the temporary immediate abutment from Nobel Biocare is filled with resin material and appears radiolucent. The temporary PFM crown is out of occlusion during centric and lateral and protrusive excursions.
It takes some special precautions when an implant is placed immediately placed after extraction and restored with a temporary restoration immediately, but the result is a happy patient.
