Post-extractive immediate implant placement and loading of screw retained crown on #11


Dr. Giuliano Garlini

Private practice limited to oral surgery, implantology and endodontics in Milan, Italy

This case present the extraction of the tooth 11 which was fractured after a dive in a swimming-pool and its substitution with an immediate implant and a screwed provisional crown. The procedure is described step-by-step from the extraction to the final restoration.
Female 54 years old

Medical history : nothing to report

Chief complain : “ I feel pain during the chewing activity and a change of position of my upper right central incisor”

Symptomatic fracture of the right upper incisor
Extraction of the tooth and immediate insertion of an implant IS II 4x13mm with simultaneous xenogenic graft
Immediate function with a screwed provisional crown
After 8 months of healing a final zirconia crown was inserted
Clinical view of the upper right incisor which is misaligned with a root fracture that is shown by the arrow

X-ray exam of the two central incisor

Frontal and occlusal view of the provisional crown with the ideal position of the vestibular parabola of the future final crown

During the surgery it is of fundamental importance the correct implant insertion that must be slightly palatal respect the post-extraction socket to obtain the best esthetic result.

After the implant insertion the gap between the implant it selves and the residual vestibular bone must be filled with xenograft in order to prevent the resorption of the thin buccal bone wall

The provisional abutment inserted before the relining of the provisional crown on it

The provisional crown in the correct 3D position thanks to the presence of 2 resin stops. In this case no connective tissue graft was inserted because the emergency profile of the right upper incisor was slightly coronal respect the contralateral upper incisor

clinical case for GAO1
The provisional crown just after the removal from the patient mouth

We need to add some resin in order to create the ideal emergency profile

The provisional crown screwed in an implant analogue just after the creation of the concave emergency profile

The provisional crown screwed in the post-extractive implant

The x-ray to check the correct insertion of the provisional crown

6 months later after the soft tissue healing

clinical case for GAO
The ideal emergency profile before the insertion of the implant transfer for the impression

The “individualization “of the implant transfert with the Hinds technique in order to give to the laboratory the correct information regarding the position of the implant and the soft tissue emergency profile

X-ray to check the correct position of the implant transfert

Picture for color of the final crown

Zirconium-ceramic screwed final crown

Final rehabilitation of the right upper incisor

X-ray of control

 This case presents immediate insertion of an implant IS II 4x13mm with simultaneous xenogenic graft and loading with a screwed provisional crown right after the extraction of tooth 11. The procedures are detailed step-by-step with practical advice.

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