J Korean Acad Prosthodont.  2012 Jul;50(3):191-197. 10.4047/jkap.2012.50.3.191.

Immediate implant placement into extraction sites with periapical lesions in the esthetic zone: a case report

• Yi JY
• Kim JH
• Han DH

• KMID: 2000208
• DOI: http://doi.org/10.4047/jkap.2012.50.3.191

Abstract

Esthetics is important in restoring maxillary anterior area. Alveolar bone resorption and loss of interdental papilla may be minimized by immediate implantation. Previous studies showed successful results with the immediate implantation in healthy extraction socket, while many of these studies objected the immediate implantation into extraction sites with periapical lesions. Recent studies, however, reported successful results of the immediate implantation into extraction sites with periapical lesions with careful debridement of extraction sockets and general medication of antibiotics prior to implantation. A 73-year-old female visited the department of Prosthodontics in oo University Dental Hospital with the chief complaint of fallen post-core and crown on left maxillary incisor. Although the incisor was with vertical root fracture and periapical lesion, the immediate implantation following the extraction of tooth was planned. Thorough socket debridement, irrigation with chlorhexidine, and tetracycline soaking were followed by immediate implantation. The general medication of antibiotics (Moxicle Tab.(R), 375 mg) was prescribed before and after the surgery. Immediate provisional restoration was delivered two days after the surgery, and the definitive metal-ceramic restoration was placed about six months later after reproducing the emergence profile from the provisional restoration. This case presents satisfying result esthetically and functionally upto two years after the placement of prosthesis with the harmonious gingival line and no loss of marginal bone.

Keyword

Immediate implantation; Periapical lesion; Maxillary anterior tooth

MeSH Terms

Aged
Anti-Bacterial Agents
Bone Resorption
Chlorhexidine
Crowns
Debridement
Esthetics
Female
Gingiva
Humans
Incisor
Prostheses and Implants
Prosthodontics
Tetracycline
Tooth
Anti-Bacterial Agents
Chlorhexidine
Tetracycline

Figure

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  Fig. 1 Intraoral photos and periapical radiograph at first visit. A: Maxillary left central incisor from labial view, B: Maxillary left central incisor from incisal view, C: Periapical radiograph of maxillary left central incisor with periapical radiolucent area.

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  Fig. 2 Post-extraction procedures. A: Assessment of extraction socket, B: Measurement of distance between marginal gingival and marginal bone with probe, C: Chlorhexidine irrigation, D: Tetracycline soaking.

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  Fig. 3 Surgical procedures. A: Drilling towards apical and palatal directions , B: Tapping, C: Implant installation, D: 1 - 1.5 mm of gap exists between implant fixture and labial bone plate.

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  Fig. 4 A: Impression taking for immediate provisional restoration, B: Initial placement of immediate provisional restoration.

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  Fig. 5 Impression taking for definitive restoration. A: Registration of emergence profile of provisional restoration using putty index, B: Reproduction of emergence profile on impression coping, C: Connection of customized impression coping.

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  Fig. 6 Definitive restoration. A: Customized abutment on definitive model, B: Metal-ceramic restoration on definitive model, C: Initial placement of metal-ceramic restoration.

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  Fig. 7 A: Intraoral photo and periapical radiograph 6 months after initial placement, B: Intraoral photo and periapical radiograph 2 years after initial placement.

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