Australasian Dentist Issue 89

Category 106 AustrAlAsiAn Dentist proFIle Figure 1 Figure 2 Figure 3 Figure 4 Dr Michael Cai Pitt Street Dental Centre Level 2, 70 Pitt Street Sydney NSW 2000 Ph: (02) 9223 4767 Immediate implant placement in maxillary second premolar with Dentium Superline implant Patient history: Patient presented with intense sharp pain on the upper left quadrant. she was a 29 years old female with no significant medical history. she had dental phobia and wore an occlusal splint for bruxism. Diagnosis: tooth 25: unrestored tooth, crack along the occlusal surface of the tooth mesial distally and the crack extends subgingival to the level of the bone crest. the tooth was unrestorable. there was adequate bone width and soft tissue volume. there was lack of bone height apical to the root. Treatment plan: treatment options of extraction, bridge, denture and implants were discussed. Due to the patient’s severe dental phobia, she requested all surgical treatment to be completed under intravenous sedation. the treatment plan involved atraumatic extraction, immediate implant placement with a Dentium superline implant and graft with Osteon ii, a synthetic graft particulate. An essix retainer with a pontic was used as provisional; the zirconia crown on a customised abutment was planned for the final restoration. Procedure: the patient was sedated intravenously with Propofol, Medazolam and Fentynl. the tooth was removed atraumatically with periotome and forceps. the site was degranulated carefully with copious amount of saline irrigation. there was no perforation of the sinus floor and the socket walls were intact. to ensure good primary stability of the implant, Densah burs were used in reverse to lift the sinus floor by 2mm. this allowed bi-cortical stabilisation of the implant. the implant, a Dentium superline 5.0mm by 10mm was then placed into the osteotomy site and engaged the sinus floor. Due to the design of the implant, a primary stability of 35 ncm was achieved. the jumping distance was grafted with Osteon ii. A poncho technique was used by placing a healing abutment through a PrF membrane. A figure of 8 nylon suture secured the soft tissue and the membrane. the case was loaded 10 weeks later with a screw retained zirconia crown on a customised abutment. the final isQ reading was 78 at crown issue. the patient was pleased that only one surgery was required. Conclusion: the standard protocol for immediate implant is to have at least 3mm of bone apical to the socket for primary stability. With the careful selection of implant and osteotomy protocol, immediate implant placement is still a possibility with lack of bone apical of the socket. u By Dr Michael Cai, BDsc (Hons) (uWA), Principal dentist Pitt street Dental Centre