immediate placement with immediate loading.pptx

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1. Immediate placement with immediate loading - A case report

2. CONTENTS Introduction Case report Treatment procedure Discussion Conclusion

3. Introduction Dental implants have become a standard treatment option for replacement of missing teeth. The protocol of placing an implant in a healed socket and subsequently restoring the implant with a prosthesis is recognized as a highly predictive treatment modality for partially edentulous patients. Conventionally, a 3-month waiting period after tooth extraction is required for soft and hard tissue healing before placing a dental implant. This is to allow for the healing of the alveolar bone. However this waiting period was a major disadvantage of this treatment modality.

4. Subsequently, attempts were made to shorten this duration of waiting period. Techniques such as early placement and immediate placement were developed. Immediate implant placement, defined as the placement of dental implant immediately into fresh extraction socket site after tooth extraction, has been considered a predictable and acceptable procedure. ---- Schwartz et al.,2000

5. Case Report Name : M. Kumari Age : 55 years Gender : female Address : rajahmundry

6. Chief complaint : patient complains of broken tooth in upper front tooth region since 10 days. Past dental history : patient underwent rct irt 11 2 years ago Medical history : no relevant medical history. Extra oral examination : no gross facial asymmetry.

7. Diagnosis and Treatment Planning Diagnosis : ellis class III fracture of endodontically treated tooth irt 11 Generalized attrition in lower anteriors Angles class 1 malocclusion with 4mm overjet and 5mm overbite. Chronic generalized gingivitis. Treatment options : 1. Conventional fixed partial denture 2. Implant supported prosthesis 3. Removable partial denture

8. Treatment plan: advised extraction and immediate implant placement with provisionalization.

9. pre-op Intra oral photographs

10. CBCT PLANNING

11. PROCEDURE

12. EXTRACTION OF 11 SOCKET MODIFICATION IN PALATAL DIRECTION 4.2X16 mm IMPLANT PLACED INTO THE NEWLY PREPARED SOCKET PLACEMENT OF OSTEOTOME EXTRACTED SOCKET ANGULATED ABUTMENT PLACEMENT POST EXTRACTION IOPAR

13. POST OP IOPAR

14. HEALING CAP SUTURING ALGINATE IMPRESSION IS MADE IMPRESSION COPING

15. Maxillary cast with abutment Milling of abutment and fabrication of screw retained temporary crown irt 11

16. GINGIVAL COLLAR IMMEDIATE LOADING DEFINITIVE CROWN

17. DISCUSSION Different implant placement and treatment protocols have evolved to achieve quicker and easier treatment times. Classification for timing of implant placement after tooth extraction (chen and buser)  Type 1 : immediate implant placement Type 2 : early implant placement with soft tissue healing Type 3 : early implant placement with partial bone healing Type 4 : delayed implant placement

18. Loading of dental implants : Immediate loading Early loading Delayed loading

19. Selection criteria of immediate placement: Achieving predictable osseointegration Anatomical considerations Maximizing esthetic results and soft tissue maintenance The surgical technique

20. ACHIEVING PREDICTABLE OSSEOINTEGRATION 1) PRIMARY STABILITY osseointegration requires a minimum of 3–5mm of intimate bone to implant contact Bone quality and quantity and surgical technique are predominant clinical determinants that affect primary stability It allows for vital bone maintenance, clot stabilization, and prevention of soft tissue collapse

21. 2) Quantity and quality of bone Misch has classified bone density into four types:   D1 is dense cortical bone D2 is porous cortical and coarse trabecular bone D3 is porous cortical bone (thin) and fine trabecular bone D4 is fine trabecular bone.

22. The ideal extraction site for an immediate implant demonstrates Little or no periodontal bone loss Adequate remaining supporting alveolar bone Adequate sub-apical bone and dense crestal bone The number of remaining osseous walls is an important parameter in case selection criteria. The presence of three to four remaining osseous walls is essential to immediate implant success and that implant failure rates significantly increase when this principle is violated.

23. Anatomical Considerations Extraction site morphology Important aspects are axial inclinations (slope), root curvature of the extracted tooth (dilacerations) location of the socket apex.

24. IMMEDIATE IMPLANT PROVISIONALIZATION OR LOADING BIOLOGICAL FACTORS MECHANICAL FACTORS PATIENT SELECTION Bone Quality Bone Volume Papilla Gingival biotype Flap design Implant diameter Implant length Screw type Self tapping HARD TISSUE SOFT TISSUE IMPLANT SIZE IMPLANT DESIGN

25. Immediate placement Indications Endodontically infected tooth Root fracture, root resorption Root perforation unfavorable crown to root-ratio CONTRA INDICATIONS Site with active infection, Insufficient bone apical to tooth socket apex (<3mm) Wide or long gingival recession. Ankylosis

26. Advantages Reduction in time and cost of therapy The reduction in surgical episodes preservation of the bone and gingival tissues. Less traumatic surgery greater patient satisfaction. DISADVANTAGES Difficulty in achieving implant stability Higher risk of implant failure Unpredictable soft and hard tissue levels The need for bone grafts .

27. The placement of a provisional restoration on a single implant in the esthetic zone has been advocated for creating a good soft tissue contour, especially in conjunction with immediate implant placement . Immediate implant placement and provisionalization can be a predictable treatment modality to replace a hopeless tooth in the esthetic zone when primary implant stability can be achieved, and the provisional restoration can be adjusted to clear all centric and eccentric contacts

28. REVIEW OF LITERATURE   Misch and judy found out that if the buccal or facial cortical plate is lost during extraction it leads to reduced bone height and thickness for implant placement after the socket heals. Khalid et al., Found out that there is a 25% decrease in the width of the alveolar bone during the 1 st  year following extraction of teeth and an average 4 mm decrease in height during the 1 st  year following multiple extractions

29. Ferrara  et al . Conducted a study combining immediate placement and early loading of 33 implants and they found satisfactory esthetic and functional results from patient's point of view. Becker  et al.   Found out that there has been 93.3% of 5-year success rate when the immediately placed implants are augmented with barrier membrane with an insignificant amount of crestal bone loss.

30. In general, approximately 5% of implants are expected to be lost regardless of the protocol being used. The success rate in maxilla has been stated as 66-95.5% and in the mandible is 90-100%

31. In the present case report, the patient’s need for immediate replacement and good esthetics were addressed. Thus immediate implant placement is one of the prevailing best treatment option for missing anterior tooth.

32. IMMEDIATE conclusion WITH IMMEDIATE TREATMENT No more waiting between extraction & restoration

33. references Misch's  Contemporary  Implant  Dentistry, 4th Edition Becker W, Goldstein M. Immediate implant placement: Treatment planning and surgical steps for successful outcome.  Periodontol 2000.  2008;47:79–89.   Ferrara A, Galli C, Mauro G, Macaluso GM. Immediate provisional restoration of postextraction implants for maxillary single-tooth replacement.  Int J Periodontics Restorative Dent.  2006;26:371–7. G Ajay Kumar -Criteria for immediate placement of oral implants – a review Biology and Medicine, 4 (4): 188–192, 2012 Mayer TM, Hawley CE, Gunsolley JC, Feldman S, 2002. The single-tooth implant: a viable alternative for single-tooth replacement. Journal of Periodontology, 73(7): 687–693.