IMMEDIATE LOAD POST-EXXTRACTIVE IMPLANT WITH PIEZOSURGICAL INSERT

Impianto post-estrattivo a carico immediato con inserto piezochirurgico

GIUSEPPE BIANCO

NICOLA TENISCI

Accidental trauma to the teeth of the anterior sector are events on the agenda, especially in childhood, but they can also happen in adulthood.

Giacomo comes to our center with severe pain in his upper incisors, reposting that he has suffered a trauma to his right upper incisor, accused during the Christmas holidays by eating nougat.

After carrying out a careful intraoral visit, we immediately proceeded with all the X-ray examinations useful to frame the situation. A first intraoral X-ray allowed us to note the evident horizontal fracture of the dental element. In cases like these, the tooth is unfortunately compromised, and it is necessary to intervene quickly in order not to incur important consequences, such as bone loss.

Fig. 1 The tooth from which Giacomo feels the strong pain coming.

Fig. 2 In radiographic investigations, the horizontal fracture of element 1.1 (right upper central incisor) is evident

We therefore proposed to Giacomo more than one solution, so that he could choose with us the one that best suited his needs, both economic and aesthetic.

In cases like this, in which the amount of bone is more than sufficient, as can be pruned from the 3D CT performed in the office, the choice is undoubtedly the replacement of the dental element with an implant, in particular, an immediate loading post-extraction implant. This means that in the same session the tooth is removed, the implant is placed, and a temporary resin tooth is mounted; after about 4/5 months – once osseointegration has taken place – the case is finalized with a ceramic crown.

For the more curious people, I will list the clinical steps performed below:

1.Diagnosis of fracture

Intraoral radiography and CT

3.Odontotomy (cutting the tooth in half) to facilitate tooth extraction without affecting the bone

Extraction of the element through piezo-surgical inserts

Preparation of the palatal bone using piezo-surgical inserts

Palatal positioning of the implant under preparation to obtain at least 35 Ncm of torque

Preliminary impression for the fabrication of an immediate provisional

Graft of deproteinized bovine bone in the jumping gap (microspace that is created between the implant and the buccal bone wall)

9.Position of the temporary resin crown screwed on the implant

10.Waiting of 4/5 months for complete healing

11.Final precision impression

12.Delivery of the final disilicate crown on zirconium abutment

Fig. 3 The piezosurgical inserts used for odontotomy and the extracted tooth cut into several parts.

Fig. 4 The piezosurgical inserts used for the preparation of the implant site.

The radiographic examinations performed on the first visit to my center, orthopanoramics and 3D CT, showed that Giacomo’s situation was solvable.

Having discussed the different therapeutic options, we opted together for an implant-prosthetic rehabilitation with immediate load of the Toronto Bridge type, both for the upper and lower arches.

Thanks to sedation and local anesthesia carried out in the center, which allow the patient to feel no pain, in a single session Giacomo underwent the extraction of his teeth, all now compromised by periodontal disease, and the placement of six implants in upper arch and six implants in the lower arch, some of which are post-extraction.

Particular attention has been given to the cleaning of the alveoli through piezosurgery, which through cavitation guarantees perfect cleaning of the extraction site.

The well-established working protocols have allowed us to help Giacomo already in the first visit: after having extracted the element, we placed a post-extraction implant with immediate load by means of the Piezosurgery ® – (Mectron), an exceptional instrument that guarantees an unparalleled control and precision and safety in the approach to fabrics that are fundamental when working in the aesthetic sector. Once the first impression was taken, we reviewed the patient the next day for the delivery of a temporary crown screwed onto the implant.

Fig. 5 A detail of the alveolus in the site preparation phase. Thanks to piezo-surgical technology and experience, both hard and soft tissues are completely intact.

Fig. 6 The implant is placed, and the jumping gap is filled with a shaped collagen membrane.

Fig. 7 The provisional on the laboratory model

Fig. 8 The provisional placed in the mouth.

After the necessary healing time, about 4 months, during which the patient was able to smile and speak with confidence, we reviewed Giacomo to verify that the implant was osteo-integrated, and we took the precision impression.

After a few days, the final ceramic crown cemented on a monolithic zirconium abutment was delivered, worked with particular attention by our dental technicians to offer the best possible aesthetics and almost absolute mimicry.

Fig. 9 The implant is well positioned and osteo-integrated.

Fig. 10 The precision impression in silicone material.

The aesthetic sector is extremely delicate to treat. It is not always possible to carry out such a fast treatment, it depends on several factors: bone quantity, bone quality, gingival biotype, the presence, or absence of the buccal cortex.

We often must solve important aesthetic problems due to post-extraction implants made when there was not the right clinical condition; a careful three-dimensional radiographic study is essential to choose the surgical technique suitable for the case.

The goal of our work is always to guarantee patients not only the success of the surgery and the integration of the implant, but also the security of being able to smile the utmost naturalness.

Fig. 11 The lithium disilicate used for the final crown guarantees an excellent aesthetic result.

Do not miss the opportunity to also follow the video posted on my YouTube channel in which I personally describe the phases of the case and where I collect Giacomo’s testimony. You can watch it here on the site or you can access my channel by clicking below (Giuseppe Bianco – YouTube), you will find numerous other testimonials and explanations.

This post is also available in: Chinese (Simplified) Italian

Impianto post-estrattivo a carico immediato con inserto piezochirurgico

GIUSEPPE BIANCO

NICOLA TENISCI

PROF. GIUSEPPE BIANCO

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