Immediate Implant with simultaneous Ridge Augmentation

The Ultimate goal of prosthetic replacement following teeth loss, is to provide a functional restoration that is harmonious with the remaining natural dentition .To achieve this goal hard and soft tissues should be properly healed with good quality and adequate volume. In the anterior maxilla the degree of horizontal bone resorption in post extraction site is nearly twice as high as that of vertical bone resorption during fi rst month. An increasingly common strategy is to preserve bone that includes the placement of dental implant into fresh extraction site. Immediate implant placement reduces the amount of time anticipated for loading and the number of surgical interventions which in turn yields higher patient’s satisfaction. Finally elimination of the wait period for primary healing of the soft tissues and regeneration of osseous structure signifi cantly shortens the overall treatment time and transitional state without teeth. This short communication about immediate implant case refl ects upon several steps followed for an immediate placement of dental implant in fresh extraction socket and outlines its advantages. Case Report Immediate Implant with simultaneous Ridge Augmentation Saurabh Chaturvedi1*, Mohammed A Alfarsi2, Mudita Chaturvedi3, Kaushik Pandey4 and Sunil Kumar Vaddamanu5 1Assistant Professor, Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia 2Assistant Professor & Head of Department, Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia 3Assistant Professor, Department of Oral Pathology, Career Post Graduate Institute of Dental Sciences, Lucknow, India 4Assistant Professor, Department of Prosthetic Dentistry, Career Post Graduate Institute of Dental Sciences, Lucknow, India 5Assistant Professor, Department of Dental Technology, King Khalid University, Abha, Saudi Arabia Dates: Received: 27 May, 2017; Accepted: 15 June 2017; Published: 16 June, 2017 *Corresponding author: Saurabh Chaturvedi, Assistant Professor, Department of Prosthetic Dentistry, College Of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia, Tel: 0580697248; E-mail:


Introduction
Immediate implant placement refers the implant placed immediately into the socket after tooth extraction [1]. It is regarded as a sustainable technique; provided that proper patient selection and meticulous surgical procedures are implemented [2]. Clinical studies have demonstrated that the success rate of immediately placed implants is similar to that implants placed after healing of extraction sites [3][4][5]. A key factor in esthetic success is presence or absence of adequate alveolar bone (height, volume, and thickness of the cortical plate) at the implant site, since the gingival contour follows the underlying osseous crest [6][7].
In maxilla, atrophy is more severe during the fi rst month of post-extraction and the loss of buccal alveolar plate following tooth extraction may lead to palatal positioning of the implants [8]. Following alveolar bone loss, an immediately placed implant should engage the bone apical to the socket for primary stability. In addition, if the angulations and location of the implant is different from the extraction socket, either a larger and tapered implant and/or bone graft material should be used to minimize the possibility of healing with soft tissue between the implant and bone. Schwartz-Arad and Chaushu [9] reported that bone chips collected adjacent to implant sites could be used to fi ll the defects without the use of membrane if the wounds could be closed by coronally repositioned fl aps.
An alternative technique known as Socket Shield Technique (SST) is an alternative approach to limiting remodeling and resorption by retaining the facial part of the root during tooth extraction. An immediately placed implant supports the facial root fragment, preventing the collapse of the buccal wall. The SST reduces the number of surgical and prosthetic interventions required to one each for pre-operative planning, surgical procedures, and prosthetic rehabilitation. The SST is a minimally invasive implantological approach offers patients and clinicians multiple benefi ts [10].
In this case report, immediate implant placement with simultaneous ridge augmentation in the anterior region is described. The fi nal restoration was in complete harmony with the surrounding hard and soft tissue and yield high degree of satisfaction from the patients.

Case Presentation
A 24 year old male patient reported to the dental clinic with the complaint of un-esthetic look in relation to upper anterior

Critical assessment of the site
Deep sub gingival fracture on palatal side in relation to maxillary left central incisor with unfavorable prognosis.
Missing area had the space of 8 mm mesiodistally and 7 mm buccolingually (Figure 2a,b). Disharmony in gingival margin with no crowding was seen in the anterior maxillary region.
There was no periapical or periodontal pathology in relation to maxillary left central incisor and had fl attened gingival zenith and thick biotype ( Figure 3).

Treatment plan
The patient was detailed about his present state, alternative treatment plans, and procedure were explained. Informed  Figure 6). Immediate temporization was done with acrylic tooth, which was splinted with the adjacent teeth with fi ber-bond splint .The patient was placed on amoxicillin 500mg thrice daily for 5 days , mefenamic acid 500mg initially ,then 250mg four times a daily for 5 days and asked to do gargle

Discussion
Ultimate result of tooth loss is reduction in bone volume, density, height and width .This results in a situation that corresponds to a condition where the sufferer will not only have compromised function but also esthetics and psychology. In this case report, the harmony of soft and hard tissue was achieved by immediate implant placement with ridge augmentation in maxillary anterior region [11]. If a bone defect is suspected, it is recommended to incise and elevate a fl ap to directly evaluate the size of the defect after curetting any epithelial tissue present. Treatment will differ based on the type and extent of bone loss. A vertical defect of less than 2 mm can be managed by horizontal osteoplasty, without compromising the restorations or the cosmetic result, vertical defect of more than 2 mm involving less than half of the implant, autologous bone may be grafted. When the bone loss is greater than 25% of the circumference of the implant, grafting