Clinical
Fig 4
CT planning position of mental foramen
to use a temporary restoration such as a resin retained bridge (Rochette), with the advantage of being able to manipulate to soft tissue contours. Dentures are not recommended as they transmit forces to the implant and can harm the healing soft tissues. The patient was also consented
for a delayed placement protocol if immediate placement was not possible e.g. compromised socket due to the loss of buccal bone. Careful discussions with the patient ensured that she was aware of all eventualities. It is also important to plan the
final restoration before surgery. It is important to meet the patient’s expectations and so a diagnostic wax-up was produced to give the patient an idea of the final result. It was explained to the patient that
the opposing teeth had over erupted and this would lead to a smaller tooth similar to the deciduous tooth. The patient was happy and stated she would prefer this. The patient was consented for adjusting the upper teeth to accommodate the implant crown if necessary.
Treatment sequence The LLE was extracted (Figure 5) as carefully as possible with a scalpel introduced into the sulcus followed by periotomes and luxators.
Fig 5 Extracted LLE
Fig 6 LLE socket
Fig 7 Implant placed in socket
The socket (Figure 6) was evaluated with a blunt probe to ensure intact margins, showing the site to be favourable for implant placement. An implant was then placed in a subcrestal position in the centre of the socket and in close contact with the bony margins (Figure 7). This ensures that the bone level is maintained around the implant4. As the implant was placed
with good primary stability, a permanent abutment was then attached within the prosthetic envelope. It is an advantage to have a number of abutments avail- able with different collar heights and angles. This is especially relevant in the anterior maxillary region when the angulation of the implant is easily corrected with an angled abutment5. Attaching the final abutment prevents bacterial ingress and bone loss associated with repeated component/abut- ment attachment and removal used in other techniques6. A pre-fabricated hollow tran- sitional acrylic crown, designed from the diagnostic wax-up, was then fitted with temporary cement (Figures 8 and 9). The transitional crown was designed to fill the socket. This stabilises the blood clot, prevents food/bacterial ingress and supports the soft tissues during the
ABOUT THE AUTHOR
Dr Tariq Ali BDS (Glas)
DipImpDent RCS (Eng) graduated from Glasgow University in 1998. He has been involved in implant dentistry for the past eight years and has trained at the Royal College of Surgeons England,
attaining the FGDP Diploma in Implant Dentistry. He is involved in mentoring and accepts
referrals for implants at his practice in Bishopbriggs, Glasgow (0141 762 3954).
healing phase. It is important that the crown has only light contact in centric and not in lateral excursions and that the patient is instructed on a soft diet so as not to overload the implant. This crown can be altered if
necessary to shape the soft tissues and develop the emergence profile. The patient can feed back any issues with this crown, so informing the dentist and technician on the design of the final restoration. In fact, on review, the patient felt the transitional crown was too large and stated she could feel it with her tongue. It was adjusted on the labial side and the height was reduced. The patient felt more comfortable with this. After three months, the implant
was fully integrated and the soft tissues healed with good contours (Figure ı0). A conventional impres- sion (medium-bodied monophase material in a metal rimlock tray) was taken of the abutment and matured soft tissues. This was then sent to the laboratory for the final restoration. The design of the final crown is
based on the satisfactory transitional crown. The crown was fitted with temporary cement (Tempbond) and a final radio graph taken (Figures ıı,
Continued » Soft
tissues shaped ready for final impres- sion
Fig 8 Pre-formed transitional crown Fig 9
Transitional crown – immediate restoration
Fig 10 Scottish Dental magazine 55
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