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01/07/2022

Immediate implant placement with immediate loading on healing abutment, customizing peri-implant area.

Authors: Gustavo Diniz Greco, Alexandre Camisassa Diniz Greco, Walkyria Camisassa Diniz Greco and Aline de Freitas Fernandes

Male patient, 45 years old.

Main complaint:

Compromised periodontal and tooth 21 mobility along with the need for aesthetic rehabilitation.

Initial assessment:

Patient sought treatment at clinic W, complaining of mobility in tooth 21. After anamnesis and intra- and extra-oral clinical examinations, two- and three-dimensional imaging tests were requested to evaluate the support structures of the maxillary anterior teeth. The need to extract tooth 21 and implant-supported oral rehabilitation were diagnosed.

Treatment performed:

The treatment plan involved a major challenge, routine nowadays, which would be maintaining and/or recovering the pink aesthetic, focusing on the health, stability and longevity of the implant-supported rehabilitation to be performed.

Planning involved minimally traumatic extraction for the supporting tissues of tooth 21, immediate placement of an Arcsys implant in the region of tooth 21, customization of the Arcsys healing abutment so that it becomes a provisional prosthesis with immediate loading, personalizing in this way, the transmucosal space and emergence profile.

Step by step:

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Figure 1: Initial extra-oral photograph;

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Figure 2: Initial intra-oral photograph;

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Figure 3: Tooth 21 after extraction;

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Figure 4: Occlusal view of the fresh alveolus;

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Figure 5: Placement of the FGM ARCSYS implant, subdrilling was used and the implant had initial locking above 40 N.

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Figures 6 and 7: Insertion of Arcsys customizable healing abutment over the implant, frontal and occlusal views;

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Figure 8: Customization of the Arcsys Healing Abutment in order to build a shape similar to a cavity preparation for a full crown;

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Figures 9 and 10: Positioning the Arcsys healing abutment on the implant and confirming the end line of the 0.5 mm subgingival preparation.

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Figure 11: Incorporating Opus Bulk fill composite resin to customize emergence profile;

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Figures 12 to 14: Incorporating Opus Bulk Fill flow resin to join the healing abutment with the customized in-stock tooth veneer and light-curing the entire set;

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Figures 15 and 16: Completion of the composite resin sculpture in the healing abutment, adjustments to the anatomical structures, rigorous finishing and polishing;

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Figures 17 to 20: Adapting the immediate provisional prosthesis on the healing abutment over the Arcsys implant. At this point, note that this prosthesis eliminates the use of cementing agents and also sutures to close the tissues, these are fundamental factors for pink aesthetic success;

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Figure 21: Final appearance of the immediate provisional prosthesis on Arcsys healing abutment;

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Figure 22: Occlusal postoperative view at 45 days, note the emergence profile and peri-implant health aspect obtained.