Page 13 - GP Fall Final 2017

Immediate Implant Placement and Provisionalization:

A Case Report

By Brian J. Jackson, DDS
Introduction digital palpation assess the health of the ex- graphs, diagnostic models, intraoral exam-
The field of oral implantology has become isting anatomy. A radiographic evaluation ination and a periapical radiograph (Figure
a discipline of dentistry with predictable demonstrates interproximal bone height, 2). At consultation, treatment options were
outcomes in the reconstruction of the par- mesial-distal dimensions and native bone presented including a single endosseous
tially edentulous patient. Research has apical to the tooth socket. implant, fixed partial denture or a remov-
demonstrated high success rates with con- able partial denture. A consent was re-
ventional implant therapy, which includes The IIPP approach exhibits several clini- viewed, signed and a time for treatment
a period of undisturbed stress during heal- cal advantages including a single flapless completion given. IIPP was discussed in-
ing. The delivery of health care has moved surgery, incorporation of growth factors cluding the advantages, indications and
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toward a minimally invasive approach to and the initiation of the restorative stage at limitations.
reduce treatment time, pain and cost. Im- surgery. The procedure provides ideal es-
mediate implant placement with provi- thetics, less pain and lower costs with few- The patient was prepped, draped and asked
sionalization (IIPP) acts in concert with er patient visits. Furthermore, a removable to rinse with a chlorhexidine mouthwash for
this approach in that it combines surgical partial denture or “flipper” is eliminated 30 seconds. Platelet-rich plasma (PRP) and
and restorative procedures, decreases the during the osseointegrative period. fibrin (PRF) were developed after a 20mL
number of appointments and eliminates the blood draw from the median cubital vein
need for a transitional removable partial The following case was the management using a standard phlebotomy technique.
denture prosthesis. of a fractured maxillary left central incisor PRP preparation was initiated after a 10mL
(#9). A diagnosis of horizontal root fracture blood draw with a vacutube containing ci-
IIPP research demonstrates comparable without restorability was established. The trate dextrose and PRF was developed after
survival rates to conventional approach- treatment plan approach was an immediate a 10mL blood draw into an empty vacutube
es in regards to early and delayed loading implant placement and provisionalization (no additive added). The blood was placed
protocols. The esthetic result is enhanced with complete rehabilitation of a missing in a single spin (Clinseal model, Salvin
2,3
because recession is reduced with the im- central incisor in two visits with one sur- Dental, Charlotte, NC) centrifuge for 12
mediate placement and provisionalization gery over a three month period. minutes for separation of whole blood into
protocol. Provisionalization supports the platelet rich plasma and platelet rich fibrin
interdental papilla and supporting soft Case History (Figure 3). 2% lidocaine with 1:100,000
tissue reducing the degree of tissue alter- A 50-year-old male patient presented to the epinephrine was administered in a buccal
ations. IIPP protocol encompasses an at- office with a tooth fractured at the gingi- and palatal infiltration technique.
raumatic extraction, implant placement and val margin. His chief complaint was, “My
a transgingival provisionalization. Guided front tooth just broke off” (Figure 1). The An atraumatic extraction of the left max-
bone regeneration utilizing various bone hopeless tooth was bonded to the residual illary central incisor (#9) was performed
grafting materials and platelet rich plas- root with a resin cement and the patient with 301, 34s elevators and 151 universal
ma/fibrin is utilized to enhance the healing was scheduled for an examination. forceps. The residual socket was degranu-
process. A final fixture level impression is A diagnostic evaluation was performed lated with a double-ended curette (Figure
performed at surgery followed by a tempo- and consisted of a medical history, photo- 4). The buccal plate, gingival sulcus and
rary abutment and crown. The final abut- socket depth were measured with a peri-
ment/crown is placed after a conventional odontal probe and a #9 Schilder endodontic
healing period has been established. The plugger (Figure 5). The osteotomy with a
procedure is predictable when a torque val- palatal skew was performed with 1.3, 2.3,
ue of greater than 35 Newton centimeters
is obtained and the buccal plate of bone is
present.
Socket classifications have been estab-
lished with emphasis on the presence of
a buccal plate of bone and height of soft Figure 1. Fractured maxillary left central
tissue. A type I socket exhibits an intact incisor (#9).
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buccal plate and ideal soft tissue contours.
A type II socket demonstrates a partial loss
of the buccal plate and corresponding loss Figure 4. Tooth socket.
of soft tissue. A type I socket is ideal for
IIPP while a type II socket is considered a
negative prognostic factor. The clinical and
radiographic evaluation is essential to de-
velop a proper diagnosis and a thought-pro-
voking treatment plan. Bone sounding,
periodontal probing, mobility testing and
Figure 2. Periapical Figure 3. Platelet Rich
radiograph of maxillary Fibrin (PRF).
www.nysagd.org l Fall 2017 l GP 12 left central incisor (#9). Figure 5. #9 Schilder plugger with rubber stopper.