Dental Implant Trauma Case

Are the crowns of the centrals whole? If so grind them out, fill with tooth colored acrylic and mount them onto "uni" abutments on your solid Astra Tech fixtures. Make sure they are out of occlusion and bonded together and to the laterals on either side. Easiest temps I have used.

If the bone is there, you could do immediate placement and load. There are alot of ifs associated with this and everything has to be worked out beforhand. I routinely do immediate placement and load on anteriors whenever I can, the healing is great and the timeframe of treatment is significantly reduced. I would definately connect the two teeth together in the temps. If you have a wax up of what you want the new teeth to look like make a shell and use that to fabricate the temps.Although this may sound daunting it's doable and once it's done the case is 75% complete. I prefer using stock abutments and again using the shell as a guide, you could machine them chairside, though not in the mouth to get the clearance and draw etc. Good Luck

We routinely treat these patients with immediate implants. We use Nobelbiocare Groovy implants and Prefabricated Zirconium or Ceramic abutments. Lab processed temporary crowns can be placed. We usually keep the teeth out of occlusion and keep light contact with adjacent natural teeth to prevent micro-movements. If occlusion is not favorable like deep overbite where you might risk overloading the case, you are better off with two stage implants. You could use bullet shaped pontics on the flipper and make sure the pontics fit into the sockets to ensure good papillae formation. Dr. G. Wadhwa

With the Astra Tech System it is very convenient to use the Zirdesign Stock abutments in this instance. You can insert them directly into the implants after placement and draw a line with a "Sharpie" marker to define the restorative margin. Then remove the abutment and prepare outside the mouth. You then torque the abutment into place (25 Ncm). You can then use your "pull-down" matrix or existing crowns to complete the temporary. By using the final abutment initially, you then limit the trauma to the epithelial tissue by not having to remove a temporary or healing abutment. One other helpful tip is to put ramps on the cuspids to keep the patient from functioning on these implants and to protect them. Credit for this technique goes to Dr. Lyndon Cooper.

I agree with the others. If the occlusion permits and if the site permits do animmediate provisional. You will have side by side implants. I personally would use Ankylose. If you can't provisionalize you could do immediate placememnt with custom healing abutments to preserve the shape of the soft tissue. Essex retainer will work or use a mayland bridge. If you can't do immediate placement, graft graft and graft.Hard and soft tissue. plan to sculpt the tissue back.

If you are not in the habit of immediate placement and loading but want to avoid a removable option, you could use an adhesive (Maryland or traditional Rochette)bridge placed on the lateral incisors. Light preparation may be necessary, but this is of little consequence to most patients (and teeth). Cementing with Panavia is reliable but can cause difficulties with removal. A narrow, straight chisel under the edge of the wing and a little tapping will allow removal and recementation, whenever you need to reaccess the site. If Panavia is too good, try Ketac-cem, but warn the patient of potential debond. (a denture in case of emergencies is useful) The fixed provisional can also be used to support the vulnerable soft tissues around the time of surgery or if you are using a socket preservation procedure, prior to placement, as described beautifuly by Sclar. The ovate and socket fitted pontics work a treat.

Has anyone heard of the continued resorption rates of autogenous bone blocs on the long run ? I have heard that resorption rates can reach up to 40 % over a period of up to three years !!! Initially it was talked of 10 to 20 % max What does this imply for the restoration of esthetic cases on the long run ? Will we get resorption, thread exposure and vertical recession ? Are there better grafting protocols ? What is your experience and what does the recent research say ?

In response to Max's question: If a block graft is done and implants are not placed into it after it has integrated, you should expect 100% resorption. The graft needs to be loaded with dental implants to prevent this from occurring. Once the implants are placed and then functionally loaded, you should expect no more resrption than that of native bone.

I have found a very high rate of resorption for block grafts. I would consider any technique that respects the biology of the bone and leaves the periosteum intact., LRE, ISL. Distraction etc. Messing with the periosteum should be avoided. There are staged techniques that work well but require a lot of skill

If immediate implants are lost in the anterior or cannot be employed for some reason, patients often reject the flipper. I have great acceptance of placing creamic brackets on the adjacent sound upper teeth and placing pontics on the wire. This is a similar concept to a maryland bridge, just bonded to the facial instead.

If you are not in the habit of immediate placement and loading but want to avoid a removable option, you could use an adhesive (Maryland or traditional Rochette)bridge placed on the lateral incisors. Light preparation may be necessary, but this is of little consequence to most patients