Maxillary Anterior Esthetic Extractions with Delayed Single Stage Implant Placement

Maxillary Anterior Esthetic Extractions with Delayed Single Stage Implant Placement
Implant Dentistry: Volume 12(1) March 2003 pp 8-9
Dyer, Scott R. DMD
Section Editor(s): Cagna, David R. DMD*; Dyer, Scott R. DMD**; Hartman, Gary A. DDS, MS***; Loughlin, Robert M. DDSÇƒÜ; Mills, Michael P. DMD, MSÇƒ?; Oates, Thomas W. Jr., DDS, PhD¨?
Lippincott Williams & Wilkins
The objective of this article is to describe several surgical and restorative techniques employed to aid in developing an esthetic anterior implant restoration. As stated in the article, the current problem with implant-based restorations is not successful osseointegration, but successful esthetic integration. Anterior edentulous spaces are prone to postextraction ridge collapse. Additionally, the maintenance of esthetic gingival architecture, especially papillae, is difficult with conventional extraction, healing, and implant protocols.
The author subjects a number of surgical techniques to assist the clinician in providing esthetic outcomes. Extraction of the tooth is recommended to be atraumatic. A periotome is suggested to cut periodontal ligament fibers circumferentially as deep as possible. Elevation of the tooth should avoid facial and lingual motions. After extraction, bleeding is verified and/or induced. The author suggests a number of grafting protocols including a combination of 80% demineralized freeze-dried bone graft (DFDBA) and 20% calcium sulfate. Additionally, barriers are used to cover the grafted material.
The article describes the use of single-stage and two-stage implant systems, though in the cases presented, single-stage systems were shown. Implant placement is critical for an esthetic outcome in the maxillary anterior region. Placement 2 to 3 mm below the CEJ, preservation of the papillary tissue, and proper angulation are noted as being important for esthetics.
Restorative procedures are also described to lend to an esthetic outcome. Two stages of provisionalization are described. The first provisionalization occurs after grafting. The goal of this phase is to provide provisional tooth replacement and to not disturb the graft. A fixed interim fixed partial denture, removable partial denture, and a modified whitening tray with a tooth replacement are all described. The second provisionalization begins after implant integration. The interim prosthesis is replaced with a provisional crown. The goal of this phase is described to form the soft tissue in preparation of a definitive restoration.
Esthetic anterior implant restorations can be initially begun with atraumatic extraction, grafting, and initial provisionalization. The process continues with proper implant placement and reprovisionalization, followed by tissue molding with a provisional crown. The definitive restoration may have a better esthetic outcome.