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Surgical Removal and Immediate Implant Placement with Buccal Bone Grafting and Composite Resin Bridge at #31

Implant Placement

Chief Complaint

Patient presented after accidentally biting into a fork while eating, resulting in avulsion of tooth #31. Patient reported excessive bleeding due to anticoagulant medication (warfarin).

Clinical Findings

  • Avulsed mandibular left central incisor (#31).

  • Patient on warfarin therapy with increased bleeding tendency.

Pre-operative CBCT taken and implant site position planned.

Treatment Plan

  • Immediate implant placement at site #31.

  • Buccal bone grafting to support implant.

  • Immediate temporization with a composite resin bonded bridge using adjacent teeth (#32 and #41).

  • Root planing of #32 and #41.

  • Patient counseled on risks, benefits, alternatives, and potential complications.

Informed consent obtained.

Pre-operative Assessment

  • CBCT reviewed to plan implant position.

  • Medical history noted (anticoagulant therapy).

Patient stable for local anesthesia.

Anesthesia

Left inferior dental nerve block, lingual nerve block, and long buccal nerve block administered.

Surgical Procedure

  • Patient prepared and draped.

  • Incision made and buccal flap raised.

  • Implant site prepared with sequential drills and osteotomes.

  • Implant preconditioned with Megagen plasma blasting.

  • A 3.0 mm × 11.5 mm Megagen AnyOne Mini Implant placed at site #31.

  • Healing abutment (3.5 mm diameter × 7.0 mm height) placed.

  • Thin buccal bone noted with implant showing through.

  • Flap released and augmented with buccal bone grafting using 6.0 mm × 10.0 mm Dentium Osteon Collagen II graft material.

  • Six interrupted sutures placed using 6/0 Surgipro Polypropylene for primary closure.

  • Hemostasis achieved and post-operative instructions given.

Immediate Restoration

Composite resin bonded bridge fabricated and bonded to adjacent teeth (#32 and #41) to temporize implant site.

Post-operative Assessment

  • Post-operative CBCT confirmed proper implant position and dense bone graft.

  • No complications noted.

  • Patient satisfied with esthetic and functional outcome.

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