Can an implant be done 20 days after of tooth avulsion?
My patient presented with a maxillary lateral incisor #10 that was avulsed 20 days ago due to intubation. Patient is a 27 years old female and requires immediate fixed replacement.
I want an opinion if we can do an implant at this site now and if not then when earliest can this patient be taken up for the procedure
19 Comments on Can an implant be done 20 days after of tooth avulsion?
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Peter Hunt
2/21/2020
Yes, this can be done now. The only real concern relates to early loading which might not be be possible as it may prevent osseo-integration. But in this situation it should be relatively simple to bond a provisional restoration in place above the newly inserted implant.
Richard Hughes DDS
2/21/2020
Yes indeed
Jason Larkin
2/21/2020
Why not. Yes.
Jason Larkin
2/21/2020
Sometimes it is even preferable because if infection was there it gives the body time to cleanup the sites prior to placement. Also tissue level more healed and more stable. Less prone to migrate south after placement because it's not so swollen.
Dr
2/23/2020
Thanks Dr Jayson
Dok
2/21/2020
Yes, as long as you get primary stability ( use wide enough implant ) and graft large gaps, go for it.
Dok
2/21/2020
.........oh, and make sure the buccal plate is intact first.
Timothy Carter
2/21/2020
No problem. BTW primary stability is only a concern if you plan to put a load on the fixture
Vipul Shukla
2/21/2020
Yes, go for it! Try to engage apical virgin bone if you can, at least 3 mm.
Now, are you sure the lateral was lost? It looks like the lateral and canine are very much in there, maybe the maxillary left central was lost? Tooth No. 21 [#09 in the US]. Please check again. Good Luck!
Dr
2/23/2020
Yes that was tooth #9 sorry my bad it is a maxillary central incisor
Carlo
2/22/2020
why was she intubated?
Was she involved in some traumatic event?
The lateral incisor seems to be missing part of the enamel.
Could an anesthesiologist be so clumsy?
mark
2/22/2020
stay in your lane. intubation is what it is and not easy.
Dr
2/23/2020
The patient underwent a C section delivery and in the process required to be intubated. I don’t know any other details as to why were they trying to intubate her etc
But she presented to me with a missing tooth
Peter Fairbairn
2/23/2020
Bit scary to lose a tooth in intubation ?? unless performed in the field , in an extreme emergency . Anyway the sooner the better .... to preserve the tissues and hence the papillae .... at least before modelling starts at about 5 weeks ..Regards
Timothy Carter
2/23/2020
It is probably poor form to be critical of the anesthesia provider considering many of the same people posting cases on this forum are inexperienced and thus seeking guidance with their implant surgery skills. I performed many intubation during my residency and know for a fact that there could be multiple factors. For now just treat the patient, now or later, and stay in your lane.
Dr
2/23/2020
Dr Carter
It wasn’t me who performed the intubation. This patient was undergoing a c section delivery and in that process required to be intubated for the reasons best known to the treating surgeons. To me, she just presented with a missing tooth and required immediate implant. I just wanted an opinion on that.
Carlo
2/23/2020
Excuse me all:
I couldld not imagine you were so touchy!
I just asked a question....
Peter Hunt
2/23/2020
If I get to hear that a patient is going to have a surgical procedure under general anesthesia, then I tend to offer to make a mouth guard for them. I know darn well when I needed surgery a year or two ago I had one made for myself!
Val
2/25/2020
This is thread is getting out of hand. The posting doctor has said multiple times he wasn't involved in the intubation nor privy to the surgery (why would he be?!) and the patient has come to him following the avulsion of a tooth 2y to this procedure. All he wants to know is if it is possible to carry out the implant placement now. THATS IT!
My answer: of course it is- I've done it following avulsion of 2 upper centrals for a 'crash intubation' at a leading university hospital's Level 1 trauma unit in the UK. This is not as rare or a matter of negligence as some on this forum are trying to make out.
I saw the patient 3 weeks later and the implants were placed and some rudimentary grafting carried out. I cut the roots off the centrals and used the crowns as poetics in a bonded bridge as the interim restoration.
It was all restored in a straightforward manner 3 months later.
This was in 2011 and the restorations are today exactly as they were then with lovely gingival countours and papillae.
Finally, we have a strong sense of 'Duty of Candour' and after explaining everything to the patient (and the hospital picking up the bill), the patient simply thanked us and the anaesthetist and nothing was taken any further.
