Early Loading of DS Primetaper Active Implant in Posterior Mandibule

INTRODUCTION

Endosseous implants have long been the preferred method of replacing lost teeth. The first endosteal titanium implant was successfully placed by Branemark in 1965. The initial protocols called for implant placement to occur in healed edentulous ridges and to indicate that the implant has healed in the extracted socket after at-least 4-6 months. Several studies conducted in the last few years have validated the safety of implants placed at that time.

According to Schwartz et al. (2000), immediate implant placement is the process of placing a dental implant into a newly created extraction socket following tooth extraction. It has been deemed a reliable and acceptable treatment. The benefits of immediately implanting into extraction sockets over delayed implant placement include the elimination of the need to wait for the bone to grow for 4-6 months following extraction and a lower rate of crestal bone loss in immediately placed implants as compared to delayed placed implants. This means that the healing period will be quick and allow the woven bone to change into lamellar bone. The natural socket has abundance of matrix and periodontal cells speeds up and improves the predictability of the healing process.

Conventional procedures state that a healing period of three to four months is necessary for the consolidation of the extraction socket. Patients often have to wait up to a year for the replacement of a missing tooth, considering the prosthetic therapy.¹

Approaches such as early or immediate loading after implant placement, instant implant implantation in a new extraction site, and immediate implant placement with early or immediate loading have been the focus of attempts to reduce the total duration of therapy.^2-4

Immediate implant loading has gained popularity recently since it reduces damage, shortens treatment times overall, slows the resorption of hard and soft tissues, increases patient acceptability, and improves function, aesthetics, and psychological well-being.^5,6 In current case report an immediate implant placement was done in mandibular posterior teeth area to preserve soft and hard tissue harmony along with reduction of treatment time overall.

CASE REPORT

A 64-year-old healthy male patient came to our clinic with retained root stump in lower back tooth region. He was not able to maintain adequate oral hygiene in lower back region. The patient was concerned and wished for the single sitting permanent solution due to frequent dental visits. Patient communicated his willingness for immediate implant placement and early loading after extraction after a detailed discussion. Patient was advised for OPG and CBCT which revealed sufficient bone for implant placement. [Figure 1]

Under local anaesthesia, the root stump was atraumatically removed. [Figure 2]

Flapless osteotomy commenced after extraction. For achieving good primary stability, osteotomy was done around 4 mm apical to the extraction socket to gain anchorage. Two PRIME TAPER EV OSSEOSPEED implants measuring 4.8 X 11mm were placed with insertion torque of more than 40 NCM was achieved. Insertion torque is the vital factor in determining, whether or not to load immediately encouraging for immediate loading. Immediately ISQ was done with Osstell ISQ device, which showed very promising readings (77and 81),

The patient was recalled after 2 months for the prosthetic procedures. ISQ test done again, which showed excellent biological stability with reading measuring in between 84-87 showing excellent secondary stability or osseointegration. Post-operative OPG was taken [Figure 4]. Thereby,

Impression was made with the impression post attached to the implant using the close tray impression technique. Shade selection was also done during this appointment. Healing abutment/ gingival former was replaced till the prosthesis in lab was manufactured. After approx. 4-7 days, the healing abutments were removed and replaced with final abutment. The PFM crown was checked for its passive fitting to abutment and non- interference with adjacent teeth. Crown was then cemented with translucent cement.Occlusion was checked. Patient was given post -operative and oral hygiene instructions. [Figure 5]

The clinical and radiographic appearance after 2 years of periodic follow up showed good esthetics, osseointegration and maintenance of bone around the implant. [Figure 6]

DISCUSSION

A successful implant procedure should not result in any technical, biological, or cosmetic complication Clinicians are increasingly adopting immediate implants in response to patient demands for accelerated rehabilitation. In certain ways, an immediate implant also stops the alveolar bone and the soft tissue from going through a sequence of adaptive modifications after extraction and keeps the socket's integrity intact.

The most common reasons for immediate implant placement are trauma, endodontic lesion, root fracture, root resorption, root perforation, unfavorable crown to root ratio (not from periodontal loss), and intact alveolar bone walls.⁷

Contra-indications include the existence of an active infection, insufficient bone (<3 mm) beyond the tooth socket apex for primary implant stability, and wide and/or long gingival recession. According to a study, following a year's follow-up, the survival percentage of immediate implant placement in posterior teeth was 96%, while the success rate in molar teeth was 93%.⁸

Patients with a history of periodontitis, bruxism, radiation, and early implant loss are at risk. The primary risk factor for implant failure is smoking more than ten cigarettes a day. This risk increases if buccal dehiscence, infection, or both are present.⁹

CONCLUSION

A well osseo-integrated dental implant without any post-operative complication was placed in posterior region. A complete preoperative clinical and radiological evaluation of the case is something we strongly support. The potential for difficulties and failures should be explained to the patient.

REFRENCE

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