Case of the Month with Dr. Tommy Fung
Straumann BLX for Immediate Placement in Posterior Mandibular Area with Sealing Socket Abutment
Immediate implant placement is one of the hot topics in implant dentistry. The benefit of immediacy is to improve patient’s overall treatment perception and quality, in terms of the reduced number of visits and healing/handicapped period, without jeopardizing long term stability(Bhola, Neely, & Kolhatkar, 2008).
Careful examination of three dimensional imaging before extraction effectively guides clinicians to proper case selection and treatment planning(Smith & Tarnow, 2013).
An implant with tapered core and enhanced thread, can offer a secure grip into the socket wall after tooth extraction. Optimum primary stability is achieved in this challenging situation. The use of an implant with chemically modified surface further speeds up the process of new bone apposition without compromising the quality of osteointegration(Buser et al., 2004).
Initial Situation Description:
• A 41-year-old female requested a consultation. Tooth 36 was found with a distal caries with subgingival extension. The restorability was guarded.
• Treatment proposed including root canal treatment, crown lengthening and full contour crown placement for 36, was discussed with the patient.
• Primary examination including CBCT was taken to examine the local situation.
• Patient elected for extraction and replacement with implant after consideration of her time and need.
• Immediate implant placement was planned to allow better adaptation to the patient’s tight business schedule.
• Hygenic phase was completed with scaling and oral hygiene instruction.
• Atraumatic extraction with sectioning and careful elevation of tooth roots were accompanished with the maintenance of intact socket wall.
• Implant (Straumann SLActive, BLX 5.5 x 12mm) was placed at correct 3D position at the interradicular septum.
• Initial primary stability of > 35Ncm was achieved.
• The space between the implant and socket was filled with particulate xenograft.
• A temporary abutment was modified with flowable composite, contoured according to the socket size and shape.
• The socket sealing abutment was further polished before tightening onto the implant ( >15Ncm ), covering the grafted area.
• Later, working impression with open tray technique was taken with a customized impression coping.
• Full milled zirconia crown with an exact copy of the emergence profile was connected and tightened to 35Ncm. Access screw hole was sealed with teflon tape and resin composite.