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Delayed Placement for a Lower Incisor
A 31-year-old patient used to be a bull fighter. One of his three lower incisors (Fig.1: 1-3) has subgingival fracture. Due to inexperience, the affected tooth is extracted and replaced by a flipper. Implant placement is planned 6 weeks later, but the patient does not like the provisional (Fig.4) and requests early placement. Four weeks post-extraction, the socket heals (Fig.2); a 3.5x20 implant is placed (Fig.3).
In addition to lab fee, the bigger hassle is that the denture needs adjustment post-implantation and readjustment 3-4 months later, when a healing abutment (Fig.4' A) is installed (to create gingival cuff for definitive restoration Fig.5).
Fig.6,7 are taken 3 years post-cementation. The gingiva fills the embrasures, as compared to Fig.5.
This case shows that delayed placement does not help the patient or the doctor. It is our first and last delayed implant placement that involves extraction of an anterior tooth. Instead immediate implant and/or immediate loading is possible, since bone density in this area is high.
Six months after the delayed placement mentioned above, the next patient happens to wear a flipper to replace #24,25 for 20 years. An accident causes mobility of #23, 26. Immediate implants are placed without immediate loading. In fact, this is my first immediate implants.
Preface to Immediate Implant for Lower Incisors
Xin Wei, DDS, PhD, MS 1st edition 03/10/2011, last revision 05/18/2018