Replacement of a single anterior tooth: Surgical procedure and three-year results

Information on patient and treatment

At the age of 14, the 42-year-old female patient had experienced trauma to tooth #11, leading to luxation and tooth mobility. Endodontic treatment had been carried out in order to correct a discoloration of that tooth aesthetically, which had begun 15 years before the intervention. About ten years after the endodontic treatment, an apex resection had been necessary to treat a periapical infection.

Owing to pulsating pain and the previous endodontic treatment, the tooth was considered hopeless with regard to an optimal long-term outcome and was to be extracted. The X-ray examination confirmed a chronic infection around the apex. The soft tissue was intact with a satisfactory attachment level to the neighbouring teeth. The quality of the rather thick gingiva was good. The incision for the apex resection had resulted in scar tissue at the junction of the keratinised and non-keratinised gingiva. Tooth #21 had been filled with a four-side composite filling at the mesial side.

 

Since the expectations of the patient regarding the aesthetic outcome were very high, we decided on immediate implant placement with a CAMLOG SCREW-LINE Implant after extraction of tooth #11. The soft- and hard-tissue structures were preserved as far as possible. Bone augmentation was performed at the time of implantation to treat the bone defect. The prosthetic treatment was to take place three to six months post-operatively, depending on the size of defect.

Conclusion

Implant-borne reconstruction of missing anterior teeth is challenging, especially in fresh extraction sockets. For a functionally and aesthetically stable outcome, sufficient hard and soft tissue is needed. Care has to be taken to preserve the existing tissue structures. Vertical and horizontal bone loss after insertion of the implant due to remodelling processes has to be taken into account.

In the present case, the patient had high expectations regarding the aesthetic outcome. An alternative treatment of this case would have been a bridge solution combined with augmentation of the pontic area. Such a solution would have held fewer risks and allowed achievement of a more predictable soft-tissue situation. The patient was informed of the risks and alternatives. However, she decided on implant reconstruction.

We aimed to preserve the soft- and hard-tissue structures to achieve an adequate level of marginal gingiva together with an adequate interdental bone peak. Therefore, we decided on immediate implant placement after extraction of tooth #11, creating optimal soft- and hard-tissue structures around the implant at the time of implant placement. The soft tissue around coronal part remained untouched and the coronal aperture was closed with a transmucosal abutment. The flap preparation was performed in the apical region only. This technique was chosen to provide the best possible interface between crown and gingiva.

We were able to achieve an ideal 3-D positioning of the implant and an optimal aesthetic result that was still stable after three years.

This article was published in Cosmetic Dentistry_beauty & science No. 4/2012.