This case involves a 39-year old male in good overall health presents pain in the anterior maxillary right area. His smile shows a gum line fracture of his right lateral Incisor. A history of endodontic treatment was reported.
A limited oral examination and radiograph reveals mobility and a vertical root fracture of a previous endodontic treatment on # 7. Radiographically, the obturated and post cored root shows an apical radiolucency. Prognosis is determined to be hopeless, and treatment options are discussed. Having the desire to leave with an immediate replacement tooth, the patient elects a proposed for treatment for the immediate extraction and the placement of a root form titanium implant supported ceramic prosthesis.
IV access is established in the right antecubital fossa, and blood is collected for the purpose of preparing a PRF (Platelet Rich Fibrin) graft per protocol. Two carpules of lidocaine with epinephrine are used for local anesthetic.
A Periotome is the instrument of choice with careful adherence to an atraumatic technique in order to preserve the buccal plate. Luxation and elevation of the root is achieved, Forceps can be used for the final delivery. The socket is thoroughly debrided and irrigated leaving only hard tissue.
A pilot hole is initiated with a palatal bias and an osteotomy performed to accept a Nobel Active type implant, in this case a 5mm x 13mm was selected. The Implant is delivered and torqued to a minimum of 35 Ncm, with 70 Ncm as ideal.
An anti-rotational Ti-base is connected to the implant platform for the purpose of screw retaining a crown. Next, the site is digitally scanned for the design and fabrication of a screw retained CEREC e.max ceramic type prosthesis. The final prosthesis, a screw retained ceramic Right Maxillary Lateral Incisor, was produced in fourteen minutes. Its design and fabrication is digitally assisted using the Sirona Cerec technology. The milled crown is then characterized with stain and glaze to meet then patient’s specific esthetic and function criteria, then fired Using an ivoclar oven with preset parameters required for this material crystallization phase.
After cooling and proper etching and priming, the prosthesis is cemented to Ti-base outside of the oral cavity using an opaque cement to preserve natural appearance. The crown is then delivered onto the implant Platform and torqued to 35 Ncm, a teflon plug and flowable resin are used to cover access hole. Contact and occlusion are confirmed and checked for any occlusal interferences which would threaten the integration of the implant.
An impression is taken and an occlusal guard is fabricated to protect the implant and prosthesis against periocclussal forces during sleep. Patient is given a regimen of antibiotics, instruction on the nightguard wear and care, and is scheduled for a week post op.
Seven days later, our patient reports no symptoms or concern, and is thrilled to have no further treatment required. Clinically, healing is uneventful, and the architecture of the soft tissue appear stable. His oral function is within normal limits. Patient will be seen in 90 days for routine care.