Post-extraction implant placement with transepithelial abutments and immediate loading

Dra. Leana Kathleen Bragança

– Degree in Dentistry from the Univ. Of Lisbon.

– Master’s Degree in Comprehensive Medical-Surgical Dentistry from the University of Seville.

– Master in Oral implantology from the University of Seville.

– Doctor of Dentistry from the University of Seville.

– Private practice in Implantology and Oral Rehabilitation in Sarria, Lugo.

Clinical history and antecedents

A 65-year-old male patient, with no medical history, came to the consultation requesting treatment for tooth No. 11 and No. 21 fractured with a mismatch of the metalloceramic crowns. Before making a decision about the treatment to be carried out, diagnostic and radiographic factors about the patient were considered: age, general and oral health, gingival biotype, as well as prosthodontic aspects (Figure 1-4).

For personal reasons, the aesthetic factor was one of the great concerns of the patient, therefore, it was decided that, on the same day of surgery, if there is primary stability of the implants, immediate loading will be carried out to the satisfaction of the patient and for shaping soft tissues.

The patient was diagnosed by cone beam tomography and, with the help of galimplant 3D computer software, the respective measurements, bone quality and quantity were made and the implant position was planned (Figure 2 (A and B)).

Figure 1 – Initial X-ray.

Figure 2 (A) – TAC section.

Figure 2 (B) – TAC section.

Figure 3 -Front view.

Figure 4 – Occlusal view.

Tooth extraction

The patient underwent an amoxicillin / clavulanic acid antibiotic treatment for one week after surgery. In case of pain or inflammation, the use of ibuprofen is recommended.

Under local anesthesia, the surgery was started with the extraction of tooth 11 and 21 as atraumatic as possible. (Figure 5-6)

Once the extraction has been carried out, the curettage and cleaning of the post-extraction socket begins. The crestal incision process is started with two distal discharges at the lateral level. (Figure 7)

Figure 5 – Extraction of crowns

Figure 6 (A)

Figure 6 (B)

Figure 7 – Elimination of the pathological process.

Implant Placement with Galimplant Stop Drills

The Galimplant®drilling protocol is performed with the stop drills, starting the protocol with the ø 2mm drill up to the ø 3.6mm drill, all 14 mm long. and two 4×14 mm IPX implants were placed with 800 rpm drilling. on the palatal side of the alveolus. (Figures 8-11)

The implant platform was located at a depth of 3 mm. of the buccal and cervical aspects of the future clinical crown, in order to achieve a suitable emergence profile. From the vestibule-palatal point of view, the implants were anchored on the palatal side of the socket to prevent exposure of threads in case of resorption of the vestibular table and, therefore, to try to avoid recession of the gingival margin that could aesthetically compromise the results. A torque of 40 Ncm is given.

Drilling protocol

Galimplant Drill Kit with Stop: Drill kit made of surgical steel, designed to place Galimplant® implants of lengths: 14 mm ø 2 ø 2.6 ø 3.2 ø 3.6 ø 4.2 ø 4.7.

(Recommended maximum 20 uses.)

Figure 8 (A) – Stop drill ø 2mm.

Figure 8 (B) – Stop drill ø 2.6mm.

Figure 9 (A) – ø 3.2mm stop drill.

Figure 9 (B) – Stop drill ø 3.6mm.

Figure 10 – Galimplant® IPX 4 x 14mm implant placement.

Figure 11 – View of the 2 Galimplant® IPX 4 x 14mm implants. (Placed).

Placement of transepithelial abutments and immediate loading abutments

Once the primary stability of the implants has been achieved, the loading process begins, for this, two slim straight aesthetic abutments of height 6 are placed and on them an immediate loading abutment that we carve for the placement of their respective temporary acrylic crown (Figure 12-17).

Bone regeneration was also performed with biomaterial (Osteoblast) and collagen membrane (Cover membrane) (Figure 13-14).

Figure 12 – Placement of the slim esthetic straight abutments

Figure 13 Immediate loading epillary placement for SLIM aesthetic straight abutments + bone regeneration.

Figure 14 – Collagen membrane placement + suture.

Figure 15 – Preparation of the immediate loading abutments.

Figure 16 – Fabrication of the temporary acrylic restoration.

Figure 17 – Provisional prosthesis.

Prosthetic protocol

Al paciente se le recomendó enjuague diario con clorhexidina durante 15 días. At 4 months, the definitive rehabilitation process began.

At 4 months, the prosthodontic protocol was started with the impression taking with an open tray. Once the provisional crowns have been removed, the soft tissue conditioning is observed (Figure 18-19).

Figure 18 – Status after four months.

Figure 19 – Emergence profile and gingival contour.

Definitive rehabilitation

Screw-retained metal-ceramic crowns are made. The 2 mm metric prosthetic screw is torqued at 30 Ncm (Figure 20-22).

The degree of patient satisfaction with the implant treatment performed was very high (Figure 23-25).

Figure 20 (A and B) – Definitive prosthesis.

Figure 21 – Final front view.

Figure 22 – Final panoramic X-ray.

Figure 23 – Final periapical X-ray.

Figure 24 (A and B) – Final RX comparison.

Figure 25 (A and B) – Final comparison of photographs.