Patient Complaint: A patient reported to our clinic with a primary concern of a broken and missing upper front tooth since the past 15 days. The patient expressed difficulty in smiling confidently and was eager for a fixed and esthetic replacement.
Clinical Examination:
- Tooth 12 (upper right lateral incisor): Root stump present
- Tooth 14 (upper right first premolar): Missing
- Surrounding soft tissues were healthy with no signs of acute infection
- Patient desired a long-term, fixed solution with minimal delay
Radiographic Evaluation: A CBCT scan was advised to evaluate the bone volume and density in the anterior maxilla. The scan revealed sufficient bone for immediate implant placement in both 12 and 14 regions.
Treatment Plan:
- Extraction of the root stump in relation to tooth 12
- Immediate implant placement in region 12
- Implant placement in the edentulous 14 region
- Provisional healing and recall after 3 months for prosthetic loading
The patient was informed about the procedure and the benefits of immediate implant placement in preserving bone and soft tissue architecture. Written consent was taken.
Surgical Procedure: Implants in Esthetic Zone
Anaesthesia: Local anaesthesia administered using lidocaine with epinephrine for patient comfort.
Step-by-Step Approach:
1. Extraction of 12 (Root Stump):
- Atraumatic extraction performed using periotomes to preserve the labial plate
- The socket was thoroughly debrided to remove granulation tissue
2. Immediate Implant Placement in 12:
- Osteotomy initiated through the extraction socket
- Sequential drilling performed under irrigation
- A narrow-diameter implant was placed with high primary stability (>35 Ncm)
- Gap between implant and socket walls filled with bone graft material to ensure optimal integration and ridge preservation
3. Implant Placement in 14:
- Mid-crestal incision made
- Full-thickness flap raised
- Osteotomy site prepared with precision
- Implant placed with adequate torque and primary stability
4. Closure and Post-op:
- Cover screws placed
- Sutures given using 3-0 silk for tension-free closure
- Immediate post-op instructions given for soft diet and oral hygiene
Follow-Up Plan:
- Patient advised to return after 3 months for crown placement post-osseointegration
- Meanwhile, a removable temporary prosthesis or clear retainer can be provided for esthetics
- Periodic review to monitor healing