Patient Overview:
A patient presented to our clinic with a long-standing complaint of broken teeth in the upper right and lower left back regions for the past 2–3 years. The patient reported significant difficulty chewing food, which was affecting their daily comfort and overall nutrition. There was no notable medical history.
Clinical Examination:
Upon oral examination, multiple dental issues were observed:
- Root stumps were present in regions of teeth 14, 16, 17, 35, and 36, indicating severely damaged and non-restorable teeth.
- Teeth 13 and 15 were found to be decayed, and sensitivity tests showed a positive response to pulp testing (TOP positive), suggesting that the pulp was still vital but inflamed.
Radiographic Evaluation: A CBCT (Cone Beam Computed Tomography) scan was advised to assess:
- Bone availability and density.
- Proximity to vital anatomical structures (like the sinus in the upper jaw and mandibular nerve in the lower jaw).
- Implant planning and angulation.
Treatment Plan
Based on the clinical and radiographic findings, a comprehensive treatment plan was established:
- Extraction of non-restorable teeth: 14, 16, 17, 35, and 36.
- Immediate placement of dental implants in the same extraction sites to preserve bone and reduce treatment time.
- Root Canal Treatment (RCT) followed by crown placement on teeth 13 and 15 to restore function and aesthetics.
- After a healing period of approximately 3 months, screw-retained crowns will be fabricated and placed over the implants.
Surgical Procedure:
Immediate Implant Placement
Day of Surgery
Step 1: Local Anesthesia The procedure was performed under local anaesthesia, ensuring the patient was comfortable and pain-free throughout.
Step 2: Atraumatic Extractions Teeth 14, 16, 17 (upper right), and 35, 36 (lower left) were extracted carefully to preserve the surrounding alveolar bone crucial for immediate implant stability.
Step 3: Site Preparation After tooth removal:
- The sockets were curetted and irrigated to remove any infected or granulation tissue.
- CBCT-guided surgical stents were used for precise angulation and depth control.
Step 4: Implant Placement Implants were placed in the extracted sockets using the immediate implant placement technique:
- Implant Size and Type: Based on CBCT measurements, appropriate implant diameters and lengths were selected.
- Primary Stability: Achieved with torque values above 35 Ncm.
- Bone graft material was used where necessary to fill voids around the implant and enhance osseointegration.
Step 5: Suturing and Post-op Care
- Flaps were repositioned and sutured with resorbable sutures.
- The patient was prescribed antibiotics, and anti-inflammatory medications, and advised on post-operative care, including a soft diet and maintaining oral hygiene.
Post-operative Follow-Up
- The patient was reviewed after 1 week for suture removal and healing assessment.
- No complications such as infection, implant mobility, or pain were observed.
- The healing was satisfactory.
Next Steps: Prosthetic Phase
After 3 months, once the implant sites have fully integrated with the surrounding bone:
- Screw-retained crowns will be fabricated for each implant.
- This will restore full chewing function, aesthetics, and confidence.
Additionally, RCT and crown placement for teeth 13 and 15 will be completed in the interim.