Canada (EN)
CLINICAL CASE
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 clinical solution
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).
Surgical procedure
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).
Restorative procedure
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).
Outcome
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.
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