Using apical surgery to prepare apical bone before immediate implant placement and provisionalization in esthetic zone-a case report

Single Immediate Implant Placement with Provisional Crown in the Esthetic Zone with 6 Years Follow-Up

Background

Immediate implant placement (IIP) has become an attractive treatment for many patients. It reduces time and the number of appointments and protects soft and hard tissue, which, in many circumstances, leads to a better esthetic outcome. IIP with provisionalization (IIPP) may contribute to a more promising result due to the guidance of soft tissue and the preservation of the hard tissue. Indications for IIPP are quite strict, and cone beam computed tomography (CBCT) is a must for case selection.

Objective

This case report will demonstrate how IIP with immediate provisionalization can result in a high esthetic outcome and no discomfort for the patient.

Case presentation

A 50-year-old female presented for implant placement following the extraction of a superior central incisor due to a vertical fracture. IIPP has been used.

Conclusion

IIPP can accomplish a stable esthetic result in the case of ideal three-dimensional implant positioning, a well-polished provisional restoration with an S-shaped buccal emergence profile, and by respecting the mesial and distal embrasure spaces for papilla maturity.

The volume of proximal bone projection can determine the osseous contour after immediate implant placement and guided bone regeneration in severe labial bony deficiency

Anterior immediate implant placement (IIP) has many biological and esthetic challenges, including inevitable soft and hard tissue loss after extraction. Previous literatures have discussed the facial bone architecture and defective socket classification. However, none of them discussed the depression of the cervical root area which can be seen frequently after IIP in type IIB and U-shaped defective sockets. In our limited experiences, we found that the labial interproximal bone edges of type IIB and U-shaped defect dominated the esthetic result after IIP. With more labial projection of the interproximal bone present, better esthetic result could be expected in the facial aspect. With adequate evaluation of this osseous scalloping before IIP, both patient and clinician could have a comprehensive understanding of the final esthetic result. This article also detailed the process of patient selection, diagnosis, surgical options, and executions required to achieve functional and esthetic success with IIP and provisionalization.