Immediate Implant Placement to Replace a Fractured Central Incisor in a Young Patient and Management of Long Term Implant Infraposition - Clinical Case Report - Home

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Immediate Implant Placement to Replace a Fractured Central Incisor in a Young Patient and Management of Long Term Implant Infraposition

Amélie Mainjot, France Lambert

This case from Amélie Mainjot and France Lambert shows how the choice of a screw-retained restoration—which allows adjustment of the profile design over time—was key to managing complications successfully. The authors’ strategic approach avoided a crown remake while also compensating for a soft tissue mismatch. A healthy 20-year-old woman, a non-smoker, presented at the emergency department of the University Hospital of Liège in February 2011 with multiple vertical fractures of tooth 21, incisal fractures of tooth 31, and an enamel and dentin fracture of tooth 32. No tooth luxation was observed. Radiographs confirmed multiple root fractures on tooth 21, including a vertical infrabony fracture, indicating that the tooth was not restorable. A pulpectomy of tooth 21 and an indirect pulp cap on tooth 32 using resin-modified glass-ionomer cement (RMGIC) (Vitrebond; 3M, St. Paul, MN, USA) were performed. RMGC (Fuji IILC; GC, Tokyo, Japan) provisional restorations were placed on the injured teeth. The patient was sent for 3D imaging (multislice CT) the next day to determine the replacement strategy for tooth 21. Because of the vertical fractures, it was important to extract tooth 21 within a few days after the trauma to limit the risk of bacterial infection and consequent tissue loss.

Surgical classification: Complex
Prosthodontic classification: Complex

Source: Treatment Guide 14
Purchase price: 10 Academy Coins
CPD/CME: 0.25 hours

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General Risk Assessment

Patient-related Factors
Oral hygiene	Fair
Compliance	Good
Patient-medical Factors
Medical Fitness	Healthy, able to undergo planned anesthesia and surgical procedure (ASA I)
Medications	No medications that would negatively affect the surgical procedure and outcomes.
Radiation Treatment	None
Growth Status	Incomplete
Site-related Factors
Periodontal Status	No history of periodontal disease, or any active periodontal disease.
Pathology near the implant site	None
Previous surgeries in planned implant site	No previous procedures.

Surgical Classification

Surgical Complexity
Timing of placement	Immediate Placement (extraction sockets) (Type I)
Simultaneous or Staged grafting procedures	Implant placement with simultaneous hard and soft tissue procedures
Anatomy
Bone Volume - Horizontal	Adequate
Bone Volume - Vertical	Adequate
Keratinized Tissue	Sufficient (>4 mm)
Soft Tissue Quality	No scars or inflammation
Proximity to vital anatomic structures	Minimal risk of involvement
Adjacent Teeth
Papilla	Complete
Recession	Absent
Interproximal attachment	At CEJ
Extractions
Radicular morphology	Uniradicular
Available apical bone to achieve primary stability	Sufficient height ( ≥ 4 mm) and width (> 2 mm around apex of planned implant)
Socket walls	Intact
Thickness of buccal wall	2mm or greater
Anticipated residual defect after implant placement	2 mm or less

Prosthodontic Classification

Complicating Factors
Biological	Screw-retained restorations with appropriate contours
Mechanical/Technical	Absence of contributing factors
Prosthesis Factors
Prosthetic volume	Adequate. Space available for ideal anatomy of the restoration
Inter-occlusal space	Adequate. Capable to create an anatomically & functionally correct planned restoration
Volume and characteristics of the edentulous ridge (fixed)	Adequate. No adjunctive therapy or prosthetic soft tissue replacement will be necessary
Occlusal Factors
Occlusal scheme	User-defined occlusal scheme achievable
Involvement in occlusion	Involvement
Occlusal parafunction	Absent
Complexity
Loading Protocol	Early/Conventional
Interim prosthesis	Tissue or interim implant supported
Implant-supported provisional restoration	Required, elevated esthetic and/or functional demands
Timing of placement	Immediate Placement (extraction sockets) (Type I)

Publication date: Oct 27, 2023 Last review date: Oct 20, 2023 Next review date: Oct 20, 2026

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