Crest Preservation with Immediate Implant Placement

This patient presented with poor prognosis for the remaining teeth and 2 implants. In the mandible, the treatment plan was to extract all the existing lower teeth, removing the 2 failed implants 45,46 (29,30), while keeping implant 33 (22) in place. Thereafter, the plan was to perform immediate implant placement of 3 implants and simultaneously augment and preserve the ridge crest. The final prosthetic plan was to provide the patient an implant overdentures on the implants.

After extraction and complete debridement, the implants (DMI Technologies Ltd.) were placed submerged, by one millimeter below the crest with good primary stability. The flap was raised, the release being be as minimal as required in order to have moderate tension during the closure, but not tension free. Hard tissue was prepared. Thereafter, Augma’s Bond Apatite Cement was used to augment the crest. After activation of the cement within its syringe, it was delivered directly from the syringe above the implants and above the crest and slightly overfilled. Thereafter, pressed for 3 seconds using a dry gauze pad above. ( An instrument should not be used to push the cement between the implant and the socket walls.)

Following the placement of the cement, soft tissue closure occurred. The cement was covered directly by the flap and no membrane was used. The flap was sutured in place with moderate tension. (It is important, when using, Bond Apatite Cement, that the soft tissue closure should not be tension free as with conventional augmentation techniques ). The soft tissue should be closed maximally without leaving more than more than 1-3mm of cement exposed.

In the 3 Months Post Op, healing was uneventful and re-entry took place after 12 weeks. During re-entry a diamond bur was used to remove excess bone grown above the cover screws. Integration of the implants was achieved and ball attachments were connected to the implants.

Surgery Performed by Dr. Ilia Mushayev DMD