QUARTER 3
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2014
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CERECDOCTORS.COM
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Fig. 1: Preoperative smile view
Fig. 2: Preoperative retracted facial view
Fig. 3: Preoperative periapical
radiograph tooth #8
Fig. 4: Galileos Implant treatment plan
Fig. 5: SiCat Optiguide
Fig. 6: Occlusal view of fractured tooth #8
Fig. 7: Insertion of Easy X-Trac screw
Fig. 8: Insertion of Easy X-Trac counter
impression tray
Fig. 9: Tooth being lifted out of the socket
Fig. 10: Extracted tooth with fractured
buccal plate
Fig. 11: Occlusal view of extraction
socket site
Fig. 12: Platelet Rich Fibrin (PRF) plug
Fig. 13: PRF plug placed into socket
The clinical decision-making dilemma
and controversy relates to the choice of
which treatment option is best suited to
counteract the post-extraction resorp-
tive process and thereby achieve the
most predictable and long-term stable
esthetic result.
This article will outline the early
implant placement technique in post-
extraction esthetic implant therapy, and
demonstrate how this technique can
be utilized to achieve a predictable and
long-term stable esthetic outcome.
CASE STUDY
This patient is a 31-year-old male with a
non-contributory medical history. The
patient was referred after a traumatic
injury resulted in a complete horizontal
fracture of tooth #8 at the gingival level,
rendering this tooth restoratively hope-
less. The initial clinical and periapical
radiographic evaluation revealed a
medium lip line, relatively short clinical
crown lengths of the maxillary anterior
teeth, an increased width of the tempo-
rarily cemented crown on the fractured
tooth #8 to compensate for the patient’s
midline diastema, and a thick peri-
odontal biotype with adequate soft and
hard tissue volume (Figs. 1-3).
A preliminary treatment plan was
devised to extract tooth #8, place an
immediate implant in site #8 coupled
with a simultaneous immediate non-
functional provisional implant restora-
tion. This first treatment phasewas to be
followed by esthetic crown lengthening
of the maxillary anterior teeth, bonding
to increase the width of tooth #9, and a
single-tooth implant restoration in site
#8 to improve the esthetic proportions
of the maxillary anterior teeth within
the patient’s smile. This treatment plan
was to be confirmed or modified as
needed after cone beam computerized
tomographic evaluation and based on
the intraoperative findings.
A cone beam CT radiographic evalu-
ation was performed with the Sirona
Orthophos XG3D CBCT machine, and
a digital impression of the patient’s
maxillary arch was obtained via scan-
ning with the CEREC Omnicam and
exported as CAD/CAM data into the
Galileos Implant treatment-planning
software where it was merged with the
CBCT scan. The Galileos Implant treat-
ment planning software was utilized to
plan an immediate tapered bone-level
implant in site #8 (Fig. 4).
However, the CBCT radiographic
evaluation also revealed a possible
fracture of the buccal bone plate at the
mid-root level, presumably due to the
previous traumatic injury (Fig. 4). The
treatment planning data was then sent
to SiCat in Bonn, Germany, for the fabri-
cation of a SiCat Optiguide (Fig. 5).
Thesurgicalprocedurewasperformed
under intravenous conscious sedation
and local anesthesia. In addition, venous
bloodwas collected and a centrifugewas
utilized to obtain a Platelet Rich Fibrin
(PRF) concentrate. After removal of the
temporarily cemented crown (Fig. 6),
the Easy X-Trac system (A-Titan) was
utilized to atraumatically extract the
fractured tooth #8 (Figs. 7-9).
Unfortunately, the preoperative suspi-
cion of a fractured buccal plate due
to the previous traumatic injury was
confirmed upon extraction of the tooth
(Figs. 10-11). It was therefore decided to
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