#Immediacy 23. Aug 2022

Guided One-stage and Two-stage implant placement in the anterior zone: a 3-year follow-up

A clinical case report by Paula Corvello, Brazil

Certain situations do not allow for immediate placement of implants in the anterior sector, mainly when the buccal plate is absent and/or the periodontal phenotype is very thin. In these cases, choosing the right surgical technique and biomaterials based on the clinical situation is critical. Furthermore, it is crucial to respect the tissue healing times before proceeding to the next phase of treatment. The following case report describes a one-stage and two-stage guided implant placement in a patient with high esthetic expectations who had to have his upper central incisors extracted due to vertical fractures. The Straumann® Bone Level Tapered Implant, with an apically tapered and self-cutting design, was used in this clinical case. Its features make it particularly suitable for situations involving poor bone quality or fresh extraction sockets where primary stability is critical.

Initial situation

A healthy 72-year-old male, a non-smoker on no medication, came to our clinic as, a few months before, he began to notice gingival inflammation and bleeding in the area of his two central incisors. He visited a previous dentist who, following the clinical and radiographic assessments, concluded that the teeth presented vertical fractures and, therefore, needed to be extracted. The patient stated that he would like to restore them in the shortest possible time and maintain pleasing esthetics until the end of the treatment.

The extraoral examination revealed a low smile line (Fig. 1) The intraoral and CBCT examination showed hopeless teeth #11 and #21 with vertical root fractures. Moreover, tooth #21 also presented an active fistula and loss of the buccal bone plate (Figs. 2-4).

The SAC classification was used, since it provides an objective, evidence-based framework for assessing the potential difficulty, complexity, and risk of an implant-related treatment associated with individual implant dentistry cases in an easy-to-use process. It also helps clinicians with patient selection and treatment planning. The patient was classified as a complex surgical and advanced prosthodontic case (Fig. 4).

Treatment planning

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