Using apical surgery to prepare apical bone before immediate implant placement and provisionalization in esthetic zone-a case report

摘要

Clinical photographs and radiographs of our case: (A) Periapical and panoramic radiograph series before apical surgery. (B) B1: Clinical photographs of apical surgery. B2: The periapical radiograph immediately after apical surgery showing the retrograde filling and grafting materials. The pathologic features were consistent with long-standing radicular cyst. (C)C1: Periapical radiograph showed tooth 11 crown crack. C2: Clinical photograph before IIPP. Tooth 11 vertical crack revealed clearly. C3: A 4.3 mm × 18 mm NobelParallel™ was placed in the socket of tooth 11 with high insertion torque (>35 Ncm). The labial gap was filled with anorganic bovine bone. C4: Screw retained provisional crown was made with temporary snap abutment. C5: Frontal view when the provisional crown of tooth 11 was installed. C6: Occlusal contact should be avoided. C7: Periapical radiograph one month after IIPP. (D) Periapical radiograph after final prosthesis was delivered. (E) Computed tomographs of tooth 11 apical area. The apex of implant was total embedded inside the grafting materials. This showed that the regenerated bone after apical surgery could support IIPP. (F) Gingiva level comparison. Black dot line and black line show the gingiva level of teeth 21 and 41 as a standard line, respectively. The sizes of tooth 21 (blue arrow line) were all equal. The pre-operation tooth 11 distal papilla level was marked with the blue line, and pre-operation tooth 11 mesial papilla level was marked with the red line. Only minimal gingival recession was noted over the mid-point of facial gingival margin and the mesial papilla during IIPP. Both the mid-point of the facial gingiva margin and the mesial papilla of tooth 11 became more satisfying after the final prosthesis was delivered. This might be due to the favorable morphology of the final prosthesis.