Tuesday, September 13, 2011

What to do when Immediate loading is not a possibility?

Immediate load / Teeth in a day/hour/minute/flavor of the month, is the hottest thing in Implant Dentistry. Patients are asking for more and more from us as clinicians. Marketing hype is nice but those of us who understand the principles of Implant dentistry know that it is not always possible.
Here is a case that I just started yesterday.

Patient 84 y.o
Retired, Loves to play golf, Loves life.
Heathy All WNL
Dent Hist: Has history of wear and wear facets on his teeth.
Edge to edge bite (may or may not be condusive for immediate load)
Fell and cut his lip open and fractured #9.
Here is the Xray

Patient has Vertical/Horizontal Root Fracture.

Treatment Options:
1) Do Nothing
2) Rct, Crown Lengthening (causing more black triangles), Post and crown
3) Extract and Fpd
4) Extract Implant, Crown
5) Forced Eruption, Rct and post core Crown

Patient chose #9. I do understand That this tooth could have been saved but patient did not want to bother with other options and chose implant.
The root was measured at 18mm, so the longest implant we had was a 16mm plus 2-3 mm subcrestal would be fine.
Here is what we did.

Tooth Extracted Atraumatically

After tooth Extraction, Implant was placed and bone graft was performed. Mixture of Cerasorb M dental and DFDBA

At this point you have realized that I did not immediately  load this case. Implant placed was MIS 4.2X16mm. Stability was at about 25Ncm. Because of the patients wear I didnt feal comfortable loading the implant right away. So now what?
Many clinicians rever to a flipper. I dont like mucosal supported restorations when implants are healing. So How will I Maintain My gingival architecture and still develop the tissue. 
Essix Retainer is one way. Only problem with an essix is they get grimy after a while. 
In comes Ribbond. Ribbons allows us to fabricate a fixed pontic that will be adjusted as the tissue heals.
We used collatape and 5-0 Chromic Suture to hold it in. Papilla not sutured but rather supported by temporary.
Here is the remainder of the case. Enjoy!
Comments are welcome
5-0 Chromic suture.Notice papilla not sutured.

Papilla SPace created will adjust gingival embrasure after swelling goes down. Leaving a black triangle will allow papilla to develop

Final Xray

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