IMMEDIATE IMPLANT PLACEMENT FOR BEGINNERS

STUDY CLUB CASE PRESENTATION: Immediate Implant Placement for Beginners :

STUDY CLUB CASE PRESENTATION: Immediate Implant Placement for Beginners Anthony J Reganato, DDS, MS Private Practice Periodontist West Suburbs-Chicago, IL “The Reganato Lecture Series” Sponsored by Woodlake Family Dental of Naperville, IL

Lecture Overview:

Lecture Overview Full Case Report Walk-Through Immediate placement Delayed provisionalization Final Restoration Placement Technique Case #1: Immediate Placement, #10 Case #2: Immediate Placement, #7 Future Discussion: Immediate Placement in the First Premolar Position

Immediate Implant Placement:

Immediate Implant Placement

Full Case Report:

INITIAL PRESENTATION Full Case Report

Favorable Factors:

Favorable Factors Lateral Incisor Position Considered one of the most ideal sites for immediate implant placement and immediate provisionalization Sites to consider: maxillary/mandibular first premolars (possibly mandibular second premolars ), maxillary lateral incisors, mandibular lateral incisors when centrals are absent or planned for concurrent extractions Thick Fibrotic Biotype More favorable tissue response to treatment compared to thin scalloped biotype (less forgiving) Low Smile Line Tissue healing not readily visible during interim stage

Slide 6:

Minimum requirement of 1mm labial bone width without dehiscence or fenestration >1mm of labial bone width may be more favorable as in this case

Slide 7:

Verify extraction socket walls are intact Verify at least 4mm of apical native bone exists below extraction socket Prepare initial osteotomy into palatal wall with round bur or lindemann bur (Centralizing osteotomy may allow positioning to change toward the labial = path of least resistance = potential for labial plate bone resorption) Finalize osteotomy with central-palatal alignment within emergence of planned restoration For every mm palatal, implant should be placed the same mm dimension apically to allow for proper emergence profile Bone grafting required if jumping gap exceeds 2mm, recommended if 1mm exceeded

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For every mm palatal, implant should be placed the same mm dimension apically to allow for proper emergence profile

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FDBA grafting of jumping gap Immediate Post-op

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2 Week Post-op 2 Month Post-op

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Papilla Preservation Incisions in Thick Biotype Regeneration of labial bone evident

Slide 12:

Use of short conical temp abutment for short robust crowns as in this case Use of long slender temp abutment recommended for long petite crowns

Evolution of Technique:

Evolution of Technique Clinical experience supports the following when immediate provisionalization was not performed: Essix retainer is superior to flipper appliance in terms of developing papillas Use of a full thickness mucoperiosteal labial flap with or without coronal advancement ( periosteal release as needed) Suturing with vertical mattress sutures using 4-0 or 5-0 chromic gut Sling suture on labial aspect optional

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Advantage of provisionalization by the surgeon: complete cement removal before flaps are sutured in order to prevent cement sepsis/eventful healing outcomes

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Immediate Post-op

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2 Week Post-op

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Initial Presentation Final Restoration

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Provisional Crown Final Crown

Immediate Implant Placement:

Immediate Implant Placement

Immediate Implant Placement 101: A Review of Placement Technique:

Immediate Implant Placement 101: A Review of Placement Technique

Slide 21:

Initial Presentation

Slide 22:

Initial Presentation Importance of Atraumatic Extraction

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Initial Osteotomy Completed Osteotomy Verify Integrity of Socket Walls Prior to Starting

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Hand torqueing of Nobel Active implant in place in order to facilitate proper orientation Final Implant Position

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Immediate Post-op 2 Week Post-op

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Initial Presentation 2 Week Post-op

Immediate Implant Placement 101: A Review of Placement Technique:

Immediate Implant Placement 101: A Review of Placement Technique

Slide 28:

Initial Presentation

Slide 29:

Initial Presentation Importance of Atraumatic Extraction

Slide 30:

Completed Osteotomy Verify Integrity of Socket Walls Prior to Starting Implant Insertion

Slide 31:

Final Implant Position

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Immediate Post-op 2 Week Post-op

Slide 33:

Initial Presentation 2 Week Post-op

THANK YOU:

THANK YOU CARNIVORE CHALLENGE “The Reganato Lecture Series” Sponsored by Woodlake Family Dental of Naperville, IL QUESTIONS AND DISCUSSION