IMMEDIATE PLACEMENT OF DENTAL IMPLANT ON FRESHLY EXTRACTED SOCKET : A CASE REPORT FROM B

* Corresponding Author Dr. Bishal Babu Basnet Assistant Professor Department of Prosthodontics College of Dental Surgery B. P. Koirala Institute of Health Sciences, Dharan Nepal Email: bidrum43@gmail.com ABSTRACT Immediate placement of implants into the freshly extracted tooth sockets is viable and preferable op on in many cases who have to wait for healing phase in tradi onal implant therapy. This has been a great boon for the implant den stry. In this case a young lady who had unusual trauma to her upper front tooth had immediate implant placed on the same day of extrac on and metal-ceramic crown restored her esthe cs a er about 4 months. With extensive treatment planning and execu on of surgical and prosthe c phases of implant therapy, immediate placement of dental implant gives wonderful results.


INTRODUCTION
Tooth loss in anterior region that too in upper jaw, poses serious psychological problem to an individual.There is concern about the esthe cs in the anterior part of mouth more o en than not.Tradi onally, the treatment of such situa ons was restora on or placement of tooth a er 1 extrac on with 2 to 3 months bone remodeling me.Implant therapy contributes many advantages like be er esthe cs, improved oral hygiene, osseous preserva on and 2 reduced future maintenance.The emergence of immediate placement of implants into fresh sockets thus has both advantages of maintenance of esthe cs immediately a er extrac on and giving pa ents most successful, quality treatment.There are many reports that show higher success rates of dental implants placed immediately a er [3][4][5] extrac on.This case report describes placement of immediate implant in freshly extracted socket and restora on of missing tooth with metal ceramic restora on a er osseo integra on.

Case report
A 35-year-old female presented to Department of Prosthodon cs, B.P. Koirala Ins tute of Health Sciences, Dharan a er referral from a local clinic.She had a history of trauma to her teeth when she was holding a baby; (the baby's head striking to her front teeth).On visual examina on nothing was significantly related to pa ent's concern (fig. 1) but with palpa on the mobility of her upper le incisor was discernible.Consulta on to Department of Endodon cs and Periodon cs was done and salva on of tooth was found to be discommodious.The orthopantomograph was taken, medical and medicinal history were obtained and all viable op ons for treatment were explained to the pa ent.With all factors taken into considera on, immediate placement of implant was decided.

Figure 1: Intra-oral examina on, the arrow showing the tooth to be extracted
A-week long chlorhexidine digluconate mouthwash (0.12%) was prescribed and next appointment was fixed.Amoxicillin 1g was given one hour prior to surgery and tooth crown and root stump were taken out without excessive explora on (Figure 2, 3) under local anesthesia with lidocaine 2% in 1:100000 epinephrine.Use of periotomes and endo file was done and extreme care was ins lled to avoid trauma to labial cor cal plate.Following minor osteotomy palatal to extrac on socket an implant 4.2 x 13 mm (Adin dental implants system ltd.) was placed which had an ini al stability (Figure 4), an orthopanto-mograph confirmed its loca on and status (Figure 5).Immediate provisionaliza on was done so that pa ent did not have to be toothless for the period of osseointegra on.A er about 4 months, uncovery surgery was performed and healing abutment was placed.It was modified to receive a temporary crown (Figure 6) for 2 weeks during which me gingiva was formed in be er margins.
In next appointment transfer coping was a ached to implant body and closed tray impression was made (Figure 7).The implant analog was a ached to impression and cast was obtained on which abutment was a ached.
The final prosthesis was fabricated a er laboratory adjustment of abutment (Figure 8) outside mouth.This reduced chair me as well as rendered the comfort to the pa ent.The prosthesis was cement retained (Figure 9).The pa ent was advised to review the implant annually and also to maintain adequate oral hygiene.

Discussion
Immediate implant placement possesses advantages of bone preserva on and has a be er success rate in anterior 3 maxillary region.However, periapical pathology can be contraindica ons for placing the implants without 6,7 regression of the lesions.Some authors claim success even [8][9][10][11] in such condi ons with proper debridement and care.Thus immediate implant placement has less contraindica ons in modern era of den stry.
Immediate temporiza on gives a huge relief to the pa ent.
Although in our context it is not always customary to use fiber-reinforced composite, it is one of the best materials to 12 be bonded on the adjacent teeth as a provisional restora on.
In our pa ent we had to rely on acrylic removable par al denture fabricated prior to extrac on, which was made a er trimming out the tooth from the dental cast.
There are different modali es of treatment in pa ents who have to undergo extrac on.Immediate placement of implant and temporiza on is preferred if there is no need of 13 extensive surgery or periodontal modifica on procedures.
Post extrac on bone loss can be thus avoided with implant 4 placement on the same day of extrac on.Some cases where ridge is deficient, ridge expansion during extrac on is 14 recommended.In our case, it wasn't necessitated based on radiographic findings.
There are some issues regarding esthe c emergence of crown in the final restora on because the op mal posi on of implant placement in well-healed socket differs from immediate placement.The use of template to place the implant in such precise posi on can compromise the esthe cs and ini al stability thus ridge expansion is to be 15 u lized.

CONCLUSIONS
The quality of life can be improved with higher success rate of dental implants for many pa ents who have to undergo tooth extrac on due to unavoidable reasons.A viable and predictable solu on in such circumstances may be immediate implant placement.With this protocol there is reduced number of surgical appointments, preven on of bone resorp on and preserva on of so ssue architecture.However, like in any other cases me culous execu on of surgical and prosthe c treatment a er proper case planning are keys for the success.

Figure 2 :Figure 3 :
Figure 2: The extrac on socket immediately a er atrauma c extrac on

Figure 4 :Figure 7 :
Figure 4: Implant was screwed and the flaps closed with silk suture Figure 7: Impression made a er a achment of transfer coping to the implant body, a er removal of impression, implant analog was a ached to coping.