Immediate Implant Placement in Anterior Maxilla

This case report describes extraction of a fractured right maxillary lateral incisor tooth which was previously treated endodontically, followed by immediate placement of a dental implant in the prepared socket and temporisation by a removable partial denture. The tooth was extracted with minimal hard and soft tissue trauma. The socket was prepared to the required depth and implant was inserted. An impression was made after four months, and a definitive restoration was placed. The atraumatic operating technique and the immediate insertion of the implant resulted in the preservation of the hard and soft tissues at the extraction site. The patient exhibited no clinical or radiologic complications after loading.


INTRODUCTION
Missing teeth and supporting oral tissues have traditionally been replaced with dentures or bridges allowing functional restoration of mastication, speech, and aesthetics. 1 Dental implants offer a better alternative.The implants are inserted into the jawbones to support a dental prosthesis and are retained because of osseointegration. 2 Osseointegration was first described by Branemark (1977), 2,3

CASE REPORT 1
A 32 year-old female reported of root stump in upper right front region and gave history of fractured maxillary right lateral incisor due to road traffic accident a week ago in which root canal therapy was done two years ago.She was referred to Department of Periodontics for needful treatment after endodontic evaluation.Patient's general and medical history were taken and was not significant.Patient was examined clinically and cone beam computed tomography was taken.After thorough analysis clinically (Figure 1) and radiographically (Figure 2) it was evaluated that there was no underlying pathology and tooth root was unrestorable.The patient was on regular recall and under strict oral hygiene measures.The patient was recalled after 16 weeks, radiograph was taken and prosthetic phase was carried out.
After soft tissue healing, impressions were made with the impression post attached to the implant using the closed tray impression technique.Shade selection was also done during this appointment.Casts with impression post-implant analogue complex, abutment, lab drivers and selected shade were sent to laboratory for preparation of cement retained Zirconium crown.After one week, the healing abutment was removed and replaced with final abutment (Figure 9).The Zirconium crown was cemented with dual cure composite resin (Figure 10).Oral hygiene instructions were reinforced and recalled for regular follow-ups (Figure 11, 12).
Gurung et al : Immediate Implant Placement in Anterior Maxilla

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as the direct structural and functional connection between living bone and implant surface.It has definitely been one of the most significant scientific breakthroughs in dentistry.Teeth may have been lost through dental diseases or trauma or they may be congenitally absent.However in many clinical situations compromised teeth or roots may still be present in the patient's mouth.Before the invention of dental implants, compromised teeth were removed and the extraction sockets were left to heal for several months.Conventionally, implants are placed three to six months after the extraction of teeth.However, the majority of patients are interested in shortening the treatment duration between tooth extraction and implant placement or even better in having the implants inserted at the same day (immediate implants) 4,5 which is well documented. 5Dr. John Gurung, 1 Dr. Bhageshwar Dhami 2 Department of Oral and Maxillofacial Surgery, Kantipur Dental College, Kathmandu, Nepal; 2 Department of Periodontics, Kantipur Dental College, Kathmandu, Nepal.

Figure 12 :
Figure 11: (a,b) One month follow-up.Figure 12: Two months follow-up.a b