Immediate implant placement and provisionalization of a maxillary premolar
Bobby Birdi, DMD, MSc
Felipe Ouriques, DDS, MSc
Angus Barrie, RDT
Catherine Chay, CDA
Immediate implant placement after tooth extraction with the Nobel Biocare N1 system. Atraumatic tooth extraction with immediate implant placed in a fresh extraction socket, then immediate loading using a temporary abutment screwed to the Nobel Biocare N1 Base Xeal™.
Patient: 79-year-old, female.
Clinical situation: Tooth with periapical pathology and root fracture of the maxillary second premolar.
Surgical solution: Extraction site, immediate Nobel Biocare N1 TiUltra™ implant, bone grafting with creos™ xenogain and PRF, screw-retained temporary crown.
Restorative solution: Screw-retained crown on the Nobel Biocare N1 Base.
Surgery date: June 2022.
Total treatment time: 1 month (final prosthetic delivered in July 2022).
Tooth position: #15 (FDI) #4 USA.
Initial periapical X-ray revealing a fracture on the premolar root and periapical lesion (left).
Initial situation buccal view of tooth #15 (center).
Occlusal aspect of the premolar crown (#15) (right).
The clinical situation of the fresh socket after atraumatic tooth extraction (left).
A buccal view showing that the tissue position and levels were maintained on the initial position (right).
Occlusal view of Direction Indicator placed after the osteotomy (left).
X-ray with Direction Indicator in position to confirm the right angulation of the osteotomy (right).
Nobel Biocare N1 TiUltra TCC RP 4.0 x 11 mm (300862) (left).
Occlusal view of the implant position (right).
Nobel Biocare N1 Base Xeal TCC RP 1.75 mm (300985) (left).
Occlusal view with the Nobel Biocare N1 Base Xeal TCC screwed and torqued in the correct position (right).
Impression made at time of surgery (left).
X-ray with the impression coping to verify that it is appropriately seated (right).
Temporary Abutment Nobel Biocare N1 Base connected directly to the N1 Base Xeal TCC (left).
Temporary Abutment post reduced to the required height to capture the temporary crown (right).
Provisional restoration in place (left).
Lateral view showing the tissue margins (right).
Lateral view after grafting with creos xenogain and PRF and the provisional in place (left).
X-ray illustrating immediate post-op (right).
Lateral and occlusal view after 4 weeks post-surgery. The tissue margin is stable.
Four weeks post-op removed the provisional (left).*
The aspect of the tissue 4 weeks after the surgery (right).*
* 4 week load time currently outside of Nobel Biocare IFU guidelines.
X-ray of the implant with the final crown (left).
Final crown placed lateral and occlusal view (right).
One month final crown buccal and occlusal view.
1-year follow-up.
-
Nobel Biocare N1™ systemChange the way you treat patients.
-
creos™ xenogain3 methods of application to meet all your bone grafting needs.
-
Xeal™ and TiUltra™Welcome to the Mucointegration™ era. Surface chemistry cells can’t resist.
Share this clinical case
Sign up for our blog update
Get the latest clinical cases, industry news, product information and more.
© Nobel Biocare Services AG, 2023. All rights reserved. Disclaimer: Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. Caution: Federal (United States) law or the law in your jurisdiction may restrict this device to sale by or on the order of a dentist or a physician. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions. creos xenogain and creos xenogain collagen are manufactured by NIBEC Co., Ltd., Iwol electricity-electronic Agro-Industrial Complex, 116, Bamdi-gil, Iwol-myeon, Jincheon-gun, Chungcheongbuk-do, 27816, Korea and distributed by Nobel Biocare USA, LLC. Disclaimer of liability: Nobel Biocare disclaims any liability for any injury or damage to any person or property arising from the use of this clinical case. This clinical case is not intended to recommend any measures, techniques, procedures or products, or give advice, and is not a substitute for medical training or your own clinical judgment as a healthcare professional. Viewers should never disregard professional medical advice or delay seeking medical treatment because of something they have seen in this clinical case. Full procedure is not shown. Certain sequences have been cut. Products featured in this case may be part of an overall concept and may only be used in conjunction with the associated original products according to the instructions and recommendations of Nobel Biocare. Non-recommended use of products made by third parties in conjunction with Nobel Biocare products will void any warranty or other obligation, express or implied, of Nobel Biocare. The user of Nobel Biocare products has the duty to determine whether or not any product is suitable for the particular patient and circumstances. Nobel Biocare disclaims any liability, express or implied, and shall have no responsibility for any direct, indirect, punitive or other damages, arising out of or in connection with any errors in professional judgment or practice in the use of Nobel Biocare products. The user is also obliged to study the latest developments in regard to this Nobel Biocare product and its applications regularly. In cases of doubt, the user must contact Nobel Biocare. Since the utilization of this product is under the control of the user, it is his/her responsibility. Nobel Biocare does not assume any liability whatsoever for damage arising thereof. Dr. Bobby Birdi is a paid consultant for Nobel Biocare. The opinions expressed are those of the doctor. Nobel Biocare is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment in treating their patients. Individual patient results may vary.