This case shows that, while it is necessary to continue to deepen and analyze this procedure in the long term, the results obtained to date are equivalent to, or more favorable than, those achieved when procedures are performed in stages. These results have been very motivating to continue to deepen this therapeutic strategy. The procedure offers the main advantages of exposing the patient to fewer surgical procedures, a reduction in maneuvers and prosthetic sessions, with a consequent decrease in clinical time and total treatment time. This technique requires extensive training as it is very technique sensitive due to the importance of the 3D implant position, the volume of soft and hard tissues and the prosthesis design.
Initial situation
The 28-year-old male patient came to our practice with no general health conditions or habits that could affect the prognosis of our treatment. After clinical examination (Fig. 1) (periapical x ray, probing, CBCT scan), a vertical root fracture was diagnosed, accompanied by a defect on the buccal and palatal walls. Various treatment options were presented and discussed together with the patient, and he decided to have tooth 21 replaced with an implant. As his oral hygiene was poor, basic periodontal therapy was performed and plaque control was evaluated weekly for one month.
Treatment planning
After careful examination of the residual bone on the CBCT scan (Figs. 2,3) we decided to opt for an immediate implant, as we believed that primary stability and high insertion torque could be obtained using the Straumann® Bone Level Tapered (BLT) Implant. Accordingly, we planned to proceed to immediate provisionalization with the patient´s own crown, and produced a silicone index so that the crown could then be repositioned in its original exact location after the extraction. Antibiotic therapy was prescribed and consisted of 1g of amoxicillin with clavulanate one hour before surgery, followed by 500mg every 8 hours for a week.
