dentist must do some quick think-
ing to recover the case and take care
of the patient.
is challenging. The bone, soft tissue,
and theimplant position must be at
the optimum for a successful case.
has a high lip line or smile line. Im-
mediateplacement of implant scan
greatly improve cosmetic success by
maintaining alveolar bone and gin-
gival contour.
delayed approach is preferred. It is
essential that the correct diagnostic
assessments be done before attempt-
ing an immediate implant.
mediate-load implants using the
NobelPerfectscallopedandtapered
implant system (Nobel Biocare;
Yorba Linda, CA). This system was
selected due to it being the closest
match to natural root anatomy. The
principles outlined can be applied
to other implant systems, as well.
placed. This is due to the fact that
the anterior maxilla slants diago-
nally to the frontal plane of the fa-
cial skeleton. Straight implants may
perforate the buccal plate and there-
fore should not be used. The goal
of treatment is to maintain existing
supporting structures and allow the
patient to continue with an esthetic
fixed restoration, even in the healing
phase.
placement with a provisional is the
best way to achieve the goal.
had been fractured near the gum
line when he was 10. Root canal
therapy had been performed when
he was 17, and a post and crown
wereplaced.Overtheyears,#9has
had three crowns, three posts, and
crown-lengtheningsurgery.Thelast
replacement of the crown was part
bonded Empress® veneers (Ivo-
clar Vivadent; Amherst, NY). Three
years later, the post loosened again
and the decision was made to plan
for replacement of the compro-
mised root with a dental implant
(Figs1&2).
some bone around the affected
tooth, so orthodontic extrusion was
performed to improve the gingival
margin contours in anticipation of
extraction and implant placement.
After four months of orthodontic
extrusion and stabilization, brack-
ets were removed and the area was
left to settle for three additional
months.
fabricated and the patient wase valu-
ated for the planned implant surgery.
It was decided to use a Nobel Perfect
scalloped 4.5-mm diameter x 16-
mm long titanium implant. The 16-
mm length would provide primary
stabilization in the bone superior
to the extraction socket. The labora-
tory-fabricated provisional restora-
tion posed some problems due to
the difficulty of predicting the exact