Treatment Plan for Anterior Immediate Implants
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52 y/o, Smoker; when he comes back for surgery, ask him whether he has
smoked less or not. Smoking is associated with higher risk of implant
failure
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He has advanced chronic periodontitis. Scaling & root planing has been
done. Ask him whether he has brushed more or not and whether he
flosses or not
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He has lost several upper teeth: #2,3,4,14 and 15. The remaining teeth
are loose, particularly #6,7, and 9 (Fig.1-4). There are several
treatment options for him. Tell him that the doctor will discuss with
him
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Double check whether he has taken antibiotic and rinsed with Chlorhexidine
at home
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First of all, #6,7 and 9 will be extracted with immediate implants and
provisional
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Since the tooth # 6 shifts the most (Fig.1 arrow), it will be extracted
first (the reason will be further explained in section #9), followed by
thorough curettage, copious irrigation and soak with antibiotic
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Prepare a large bowl for Normal Saline and small one for Clindamycin.
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Cut a 2x2 into small pieces (9) and soak in Clindamycin solution, insert one
piece into the socket, then irrigation, repeat these steps 3 times.
When the socket is pretty clean, use a plastic pipet to collect blood
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Use the teeth #5,7 as guides for #6 pilot drill (Tatum) trajectory, with
depth ~14 from gingival margin until the drill is relatively stable
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Then ext #7, curettage, rinse, antibiotic soak, rinse, pilot drill (Bicon,
possible with drill extension)
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Take PA with 2 pilot drills in place.
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Bicon reamers, save bone, later mix with synthetic bone (Osteogen), reamers
until 3.0 mm for #7, 3.5 for #6, tap 4.5x20 for 6, then 5x20, possibly 6x20
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Take PA again with 3.0 mm reamer in #7 socket, a tap in #6
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Place implants as palatally as possible. Use Tatum tapered drills if
orientation changes unfavorably
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Try in abutments. If straight, no cementation; prep
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Use crown forms for temporary crowns. Check occlusion
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Bone graft deep portion of buccal sockets
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Cementation, remove cement thoroughly
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Then more bone grafting in the more coronal portion of the sockets
Return to
Assistants,
Upper Incisor Immediate Implant
Xin Wei, DDS, PhD, MS 1st edition 10/26/2013, last revision
04/27/2014