Extraction of Periodontally Compromised Lower Incisors with Immediate Implant Placement and Temporary Bridge (#41 & #42)
Surgical Procedure
Chief Complaint
Patient presented with pain and severe mobility affecting the lower central and lateral incisors (#41 and #42).
Clinical Findings
Teeth #41 and #42:
Very tender to percussion and palpation.
Grade I mobility.
Deep periodontal pockets.
Combined periodontal-endodontic involvement.
Purulent infection present.
Pre-operative CBCT reviewed for implant planning and assessment of surrounding bone.
Treatment Plan
Extraction of non-restorable teeth #41 and #42.
Drainage of infection.
Immediate placement of two dental implants.
Bone grafting around implants using collagen-containing synthetic bone graft material.
Immediate provisional splinted bridge.
Post-operative CBCT to confirm implant positioning.
Pre-operative Assessment
The patient was informed that teeth #41 and #42 had a poor prognosis due to combined periodontal and endodontic disease.
Treatment options, including:
Tooth extraction.
Tooth replacement options.
Immediate implant placement.
Risks, benefits, expected healing, and possible complications.
Pre-operative CBCT was reviewed to assess bone availability and plan implant positioning.
The patient understood the proposed treatment and provided informed consent.
Anesthesia
Local anaesthesia administered to the surgical sites.
Surgical Procedure
Extraction Phase
Teeth #41 and #42 were atraumatically extracted.
Purulent infection was drained.
Haemostasis achieved.
Implant Placement
The patient was cleaned and draped under sterile protocol.
Crestal incision made and buccal flap elevated.
Implant osteotomies prepared using sequential implant drills and osteotomes.
Two Megagen AnyOne Mini Implants (3.0 mm × 10.0 mm) were prepared using Megagen Plasma Blast technology and placed at sites #41 and #42 with satisfactory primary stability.
EZ Post abutments were connected to both implants.
Bone grafting was performed using Dentium Osteon II Collagen synthetic bone graft material to support the peri-implant bone.
Flap released and primary closure achieved with seven interrupted sutures.
Haemostasis confirmed.
Immediate Temporisation
Implant abutments were temporised with a splinted temporary bridge.
Temporary bridge was cemented using temporary cement.
A post-operative CBCT confirmed:
Accurate implant positioning and angulation.
Inferior Dental Nerve remained uninvolved.
Dense bone graft adaptation around the implants.
Post-operative Assessment
Infection successfully drained.
Immediate implants demonstrated satisfactory primary stability.
Temporary bridge remained stable.
Bone graft well adapted around the implants.
Post-operative CBCT confirmed ideal implant positioning.
Inferior Dental Nerve remained intact.
Patient was satisfied with the treatment outcome.