Australasian Dentist Issue 89

Category 84 AustrAlAsiAn Dentist A trauma on the front teeth can have severe consequences, especially for this young patient. After the accident, the dentist at the emergency diagnosed a subluxation of tooth 11, but failed to splint the damaged root. the patient consulted her private dentist, who suggested the tooth is failing and recommended a consult with the implant surgeon and prosthodontist. unfortunately, the tooth became very loose at the consult in my practice. the prognosis of splinting the tooth, performing an endodontic treatment had a doubtful outcome, after which the patient opted for an extraction and implant placement. Although implant therapy has been recognized as a treatment with a high survival and success rate, implants placed in the esthetic are still challenging. Perfect 3D implant position is crucial, as well as the management of the bone and soft tissue to achieve nice pink and white esthetics. in the past i have performed many extractions, bone augmentations and delayed implant placement. the treatment was predictable, but numerous surgeries do have inferior outcomes. Contemporary implant surgery is on the other hand proper planning with clinical pictures, Cone Beam Computed tomography scanning (CBCt) as well as intra-oral scanning for 3D surface texture lithography (stl), which gives us 3D models of the dentition. the 3D information can be combined and matched in a planning software (r2gate planning software). in this case the 11 could be extracted, followed by immediate implant placement in the apical palatal root and by choosing a longer implant then the root, primary stability could be achieved with the use of an implant with sharp threads. When the primary stability can be achieved over 35ncm, according to the literature and expert opinion of the author, immediate loading does not lead to more failures. this is very beneficial because the patient has a fixed temporary from the start of the treatment. to achieve the best implant position in the alveole of the 11 after extraction, i decided to place the implant with the use of guide. the r2Gate Center (Dentalab, estonia) printed a guide which corresponds with the guided surgical drills of MegaGen implant Company as well as a printed temporary PMMA crown (shade A1) which was cemented to an original titanium abutment. this gives a screw retained temporary crown. the patient had no medical conditions nor used any medication. she was planned for surgery 11 implant placement and received medication of 2 grams amoxicillin to be taken 1 hour prior to surgery and ibuprofen 600 mg analgesia postoperatively and last a rinse solution with active oxygen (Blue M Mouthwash). After anesthesia the 11 could be easily removed. On the pre-operative CBCt planning labial bone wall was visible but detached from the extraction alveole. this resulted in suppuration on probing and a pocket of 10 mm at the labial side. Hence, i made a papilla preservation flap and curetted the granulation tissue which was on the labial side as in the periosteum. the fit of the guide has to be checked, since with an improper seating of the guide the implant can end up in a different position as planned. the guide of the r2gate center is without a sleeve and just an opening of 5 mm diameter in which the surgical drills fit with small friction. the drill sequence Trauma: how to place an implant and temporary crown immediately Immediate implant placement can become very challenging after a trauma, especially in a young patient. By use of proper 3D planning and guided implant placement it is possible to achieve predictable results. lInICal By Irfan Abas Figure 2 Planning in the R2gate software Figure 1 Subluxated 11