Clinical Realities

PPAD A

SINGLE-TOOTH REPLACEMENT OF AMAXILLARY CENTRAL INCISOR VIAIMMEDIATE IMPLANT PLACEMENT

Christopher D. Ramsey, DMD, PA*

*Private practice, Jupiter, FL.

Matching a single restoration to the adjacent den-tition remains a significant aesthetic challengefor dental professionals. The innate characteri-

zations of the neighboring teeth must be precisely repli-cated in the restoration, which must not only exhibit theproper shape, but also surface texture, contours, andshade. Even when a single-tooth implant is used in con-junction with prosthetic restorations for the adjacent den-tition, the clinician must still manage the emergence profileand the soft tissue contour around the implant restorationin order to ensure the final result is harmoniously inte-grated within the patient’s fixed prosthetic restoration andthe opposing dentition.

Fortunately, the process of implant dentistry has grownincreasingly predictable, and clinicians today can selectfrom implants with biocompatible geometry and surfacesas well as prosthetic components fabricated of durablematerials (eg, zirconia). The performance of these com-ponents allows the members of the restorative team tofocus on meticulous surgical and restorative techniquesthat expand the indications for implant placement, reducethe duration of treatment, and more effectively maintain

1A 1B

Figure 1A. Preoperative view of the patient, who presentedfor relief of pain associated with her right maxillary central incisor.

Figure 1B. Postoperative view of the patient demonstrates integration of the single-unit implant and the adjacent prosthetic restorations.

the hard and soft tissues. One such technique, simultane-ous tooth extraction and immediate implant placement,enables the clinician to provide the patient with a provi-sional restoration that satisfies aesthetic and phonetic con-cerns during implant osseointegration. When performedfor a single maxillary central incisor, as in the followingpresentation, this technique can provide support for theperi-implant tissues and maintain papilla height and gin-gival architecture for the duration of the healing period.

Case PresentationA 63-year-old female patient presented for treatment ofpain she experienced upon occlusion on tooth #8(11).Comprehensive clinical and radiographic examinationrevealed a fracture of the central incisor, which was pre-pared for removal. Following a discussion of the avail-able alternatives, a treatment plan involving immediateimplant placement and subsequent restoration of the adja-cent dentition was proposed to the patient for aestheticand functional reasons. Once the patient accepted thisplan, she was appointed for implant placement with the periodontist.

5470_200706PPAD_Clin_Realities.qxd 6/19/07 9:27 AM Page A

Clinical Realities

B Vol. 19, No. 6

2A 2B

3A 3B

4A 4B

5A 5B

6A 6B

5470_200706PPAD_Clin_Realities.qxd 6/19/07 9:27 AM Page B

Figures 2A,B,C. Periodontal probing was performedat the facial and interproximal aspects of the failing toothin order to determine the extent of the dentogivingivalcomplex. The probing depths appeared to be within nor-mal limits except on the distal facial, where the probingwas found to be greater than 9 mm.

Figures 3A,B,C. To separate the failing maxillarycentral incisor from its periodontal housing, a sulcular inci-sion was made by the periodontist. The tooth was thenatraumatically removed from the bony socket without flapelevation, in order to preserve the soft tissue architecture.The tooth site was debrided throughout with curets anda saline rinse, and the implant (ie, Osseotite Certain,Biomet 3i, Palm Beach Gardens, FL) was immediatelyplaced using the free gingival margin as a reference forproper positioning.

Figures 4A,B,C. The implant was positioned to avoidcontact with the labial bone plate, which could havecaused inadvertent bone resorption and apical soft tis-sue migration postoperatively. Once the implant wasplaced, it was torqued to 35 Ncm to make it viable toreceive the single tooth provisional. A restorative abut-ment was connected to the seated implant and preparedfor the acrylic provisional restoration, which would main-tain tissue contours during osseointegration.

Figures 5A,B,C.The provisional restoration wasseated out of occlusion with the opposing dentition, andthe site was allowed to heal for four months. At that time,the provisional restoration was removed, and the hardand soft tissues were evaluated to confirm their contour.An impression was made at the implant level and usedin the laboratory fabrication of the definitive zirconia abut-ment as well as in the fabrication of the all-ceramic crownsfor the implant and adjacent natural teeth. The provisionalrestorations were then reseated.

Figures 6A,B,C. The definitive all-ceramic crowns(ie, IPS Empress, Ivoclar Vivadent, Amherst, NY) weresecured with self-etching cement. Tissue response on theday of insertion was optimal around the implant and fixedprosthetic restorations. At four and eight weeks postoper-atively, the soft tissue architecture appeared natural, andthe patient was restored to ideal health and aesthetics.

AcknowledgementThe author mentions his gratitude to Karina F. Leal, DMD(Periodontist), David Haley, and Tony Guerra (LaboratoryCeramists) for their respective contributions to this case.

PPAD C

Ram

sey

2C

3C

4C

5C

6C

Address correspondence to: Christopher D. Ramsey, DMD, PA500 University Boulevard, Ste. 109, Jupiter, FL 33458Tel: 561-626-6667 • E-mail: drramsey@ritterandramsey.com

5470_200706PPAD_Clin_Realities.qxd 6/19/07 9:27 AM Page C