IMPLANT PLACEMENT IN ANTERIOR MAXILLA: A CASE REPORT

ABSTRACT

Implant therapy is today widely regarded as a reliable treatment option to replace missing teeth, both for function and esthetics. Dental implants may be used to replace single teeth, replace multiple teeth, or provide abutments for complete dentures or partials. This topic focuses on the placement of dental implants. The correct surgical placement of a dental implant is mandatory to obtain the ideal aesthetic result. Only through proper treatment planning can the correct position and number of implants be determined. Before surgical placement of a dental implant, the adequate hard and soft tissue must be available. The clinician must consider the time needed for implant integration and soft-tissue healing, creation of emergence profiles, occlusal forces in relationship to progressive loading, and occlusal forces on the final restoration.

Key Words – Implant, Esthetic Zone, Abutment, Prosthesis

INTRODUCTION

Placing dental implants in the esthetic zone is considered to be the ultimate challenge for many dentists. The use of dental implants in the esthetic zone has overcome many of the disadvantages of conventional restorative techniques that used anterior natural teeth as abutments. Professionals aimed at creating an implant-supported restoration that replicated natural teeth.[1] That is why the single-tooth, implant supported restoration in the anterior region remains a challenge.[2]

Patient acceptance of dental implants in the esthetic zone is increasing due to many factors, including the outstanding results shown in the media. In the past, available bone often restricted placement of implants into areas such as the anterior maxilla. Today prosthetic requirements dictate, to a great extent, the placement of dental implants. Advancements in the field of dental implant therapy have lead to predictable survival rates of dental implants.[3]

The current definition of success in addition to long-term predictability, function and integration of the implant focuses on esthetic considerations.[4]

In the anterior maxilla this is more critical due to the visibility of the region and if a high lip line is present, the smile line is more revealing thus increasing the need for an esthetic result, with some authors ranking function and aesthetics in the anterior maxillary region to be of equal importance.

The mucosal contour may cover the actual alveolar ridge dimension, making it difficult to determine the degree of bone deficiency. However, CBCT, Denta Scan, and ridge mapping can all be useful.

In present case patient had esthetic issue which were resolved by placing two ImplantSwiss implant in anterior maxilla.

CASE REPORT

A 20-year-old male patient presented to the clinic with chief complaint of loss of upper front teeth due to trauma since 2 year back. On detailed intra oral examination revealed that missing teeth on 11,21 regions. Patient was wearing removable partial denture for last 2 years. The patient was in good health with non-contributory medical history, good oral hygiene and a strong desire to restore the area with a permanent fixed prosthesis [Figure 1]. Two Implant Swiss implants w.r.t 21,11 was planned.

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Figure 1a,1b: Intraoral photographs

SURGICAL PROCEDURE

The surgical procedure was performed in sterile surgical field. Preoperative decontamination of oral cavity with chlorhexidine 0.2% mouth rinse for 1 min and perioral skin disinfection with 5% povidone-iodine solution was done. Site was anesthetized using 2% Lidocaine with 1:80000 adrenaline. [Figure 2a,2b ]

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Figure 2: After removal of RPD

Horizontal incision on the alveolar crest and two vertical releasing incisions were given and a full thickness flap was reflected. A knife edge type ridge was seen on reflection of flap. Meanwhile, 2 Implant Swiss implants were placed in 21,11of size 3.3 X 12 ,3.7 X 14 to restore that segment with fixed prosthesis. More than 30 NCM Insertion torques was achieved. ISQ measurements was in range of 80-82, thereafter healing abutment was placed. Temporary, crows were given. Post operative instructions were given to the patient, and was asked to report after 7 days patient for suture removal. [Figure 3a,3b,3c]

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Figure 3a,3b,3c: Implant placement

The patient was recalled after 4 months for the prosthetic procedures. ISQ test done again, which showed excellent biological stability with reading measuring in between 84-87. Thereby, showing excellent secondary stability or osseointegration. The abutment was removed and an impression coping placed, followed by a digital impression. The impression coping was removed and abutment was replaced. Digital impression was taken as an alternative to a conventional, rubber-based technique, angulated stock abutment was attached to the implant after removal of the provisional crown. With a digital scanner capturing the position of the scan body, a digital file was created, facilitating CAD/CAM fabrication of a custom zirconia abutment. [Figure 4a,4b]

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Figure 4a,4b: Digital impression

The final crown, porcelain pressed to an PFM was seated on the final abutment. Then the final crown was cemented onto the custom abutment. Excess cement was removed and the occlusion was again verified. [Figure 5a,5b,5c,5d]

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Figure 5a,5b,5c,5d: Post-operative photographs and x-ray

After 7 days, patient was recalled for follow up. The patient was very happy with the final aesthetic and functional outcome. [Figure 6]

Figure 6: Follow up OPG

DISCUSSION

This case report discussed the key concepts of treatment planning, implant surgery, and prosthetic rehabilitation needed to achieve aesthetic success in the maxillary anterior region.The use of dental implants in the maxillary anterior region to replace missing teeth is a viable treatment option. There are many benefits of fixed dental implant-supported prosthetics 0versus traditional crown and bridge or removable tooth borne prosthetics. [5] Maintenance of residual bone, ease of oral hygiene, increased longevity, and non-involvement of adjacent teeth are a few advantages of using dental implants. In order to provide successful and aesthetic dental implant treatment, certain clinical parameters must be met.

This is particularly true in the anterior maxilla, where the teeth and their supporting structures are readily visible. Successful implant treatment to replace missing teeth in the anterior maxilla requires preoperative planning and a specific surgical plan, and ultimately prostheses are fabricated in consideration of function and soft tissue support.[6] Technical expertise is also essential. Treatment planning must consider the final prosthetic result, so that implant surgery can be tailored to fulfill the preplanned objectives. Unless the position of the final prosthesis is visualized prior to surgery, the placement of the dental implants may not allow the desired end result to be achieved.[7]

Implant placement in three dimensions is required to achieve an ideal emergence profile. Implant mesiodistally placing necessitated 1.5 mm of gap between implant and neighboring teeth or in the space between implants.[8] The placement of the labio-papillae is also crucial; a labillay that is too much forward might cause recession because the buccal bone becomes thinner and over contour the crown.[9]

CONCLUSION

Placing dental implant in the maxillary anterior region requires precise planning, surgery, and prosthetic treatment. This case report has illustrated the steps needed to create ideal aesthetics in the maxillary anterior region. Rigorous treatment planning allows the implant surgeon, working with the restorative dentist, to select location, angulations, and spacing of dental implants to achieve ideal aesthetics. The prosthetic restoration of a dental implant must be ideal to achieve the desired aesthetic result. This case report has discussed the importance of a comprehensive and interdisciplinary approach to treatment planning, surgery, and restoration of dental implants in the maxillary anterior region of the mouth.

REFERENCES

1. El Askary AS. Aesthetic considerations in anterior single tooth replacement. Implant Dent. 1999;8:61-67.

2. Spielman HP. Influence of the implant position on the aesthetics of the restoration. Pract Periodontics Aesthet Dent. 1996; 8:897-904.

3. Bashutski JD, Wang HL. Common implant esthetic complications. Implant Dent. 2007; 16(4):340-8.

4. Simeone P, De Paoli C, De Paoli S, Leofreddi G, Sgrò S. Interdisciplinary treatment planning for single-tooth J Esthet Restor Dent. 2007;19(2): 79-88;

5. Misch CE. The importance of dental implants. Gen Dent. 2001;49:38-45.

6. Tischler M. Dental implants in the esthetic zone. Considerations for form and function. N Y State Dent J. 2004;70:22-26.

7. Kopp KC, Koslow AH, Abdo OS. Predictable implant placement with a diagnostic/surgical template and advanced radiographic imaging. J Prosthet Dent. 2003; 89:611-615.

8. Figliuzzi M, Mangano FG, Fortunato L, De Fazio R, Macchi A,and GI. Vertical ridge augmentation of the atrophic posterior mandible with custom-made, computer-aided design/computer-aided manufacturing porous hydroxyapatite scaffolds. JCraniofac Surg.2013;24(3):856–9.

9. Mangano F, Macchi A, Shibli JA, Luongo G, Iezzi G, Piattelli A, et al. Maxillary ridge augmentation with custom-made CAD/CAM scaffolds. A 1-year prospective study on 10 patients. JOral Implantol. 2014;40(5):561–9.