Immediate Implants of the Maxillary Incisors
Immediate implantation makes it possible to place an implant in the most ideal position and prevent black triangles. Immediate implantation is not enough. Immediate provisional should be provided for the best cosmetic and psychological results. A flipper not only increases lab fee, but also increases the chance of micromotion of the implant, leading to implant failure. The most important aspects are to achieve primary stability and make sure that there is no occlusal contact of the involved restoration.
When the primary stability cannot be achieved (either because of implant design, bone quality or iatrogenity), the immediate provisional can be splinted to the neighboring teeth for fixation.
For the lateral incisor, particularly of females, one piece implant is indicated. For complicated cases, comprehensive treatment including ortho may be required (1).
Cases | Planning | Surgery | F-U | Cases | Planning | Surgery | F-U |
Immediately Post Trauma | Provisional | Wire Fixation | Endo-Perio Disease | Anatomic Abutment | Endogain | ||
Long Term Post Trauma | 1 | Vertical Root Fracture | Labial Plate Repair | Senior Lady, Soft Bone | Angled Abut | ||
Why It Fails | 1 | From Flipper to Implants | 1-Piece Implant | Apical Buccal Perforation | |||
Tissue Deficiency, Diabetes | 1 2 | 3 | Buccally Displaced Root | Good Vision Precise Entry | Subcrestal Placement | ||
2 Adjacent Implants in Female | 1 | 2 3 4 5 6 7 | Redo | #10 Space Issue | Small Implant | 2.5 mm 1-Piece Implant | |
Two Mesiodens | 1 | 2 | Severe Deep Bite, Possible | Buccal Plate Defect | Angled 1-Piece Implant | ||
Comprehensive Treatment | 1 2 3 4 | 5 6 7 8 9 10 | #8,9 Atrophic Ridge | 2.5 mm 1-Piece WH | Possible Buc. Perforation | ||
Severe Periodontitis | Nasal Lift | Wide Lateral Edentulous Space | with Diastemata | 1-Piece Implant | |||
Periodontitis, Bruxism | 4.5x20 mm Screw Implant | #10 Fractured Crown | 1 or 2-Piece Implant | Existing Crown | |||
Smoker, Periodontitis | 1 | 2 | #8,9 Post-Related Crown | Fracture | Existing Crowns | ||
Difficulty in Non-immediate | 1 | 1 2 3 | #8 Severe Atrophy 6 mm Cuff | or Mill Abutment | Change to Long Imp | Redo | |
Long Implant | 1 | #8 Horizontal Root Fracture | Longest Implant | Hollowed Crown | Sticky Bone | ||
Protrusive Centrals | 1 | 2 | #7,8,10, Flapless | Angled 1-Piece | Flap for #7,8 | ||
Incisive Canal | 1 2 | #9 Crown/Post Fracture | Non-Gold Coated | 4 mm Abutment | |||
Low Torque: Senior | Immediate | No Buccal Plate | 9 Exfoliation; Exostosis | Incisive Canal | |||
Trajectory | Small Implants | Abutment Diameter | #8 Redo | #10 Thin Buccal Plate and | Thin Bone | Narrow Mesiodistal Space | |
Labial Plate Defect | Tuberosity | 7-10 Chronic Periodontitis | Large Incisive Canal | 2.5 mm 1-Piece Implants | |||
Bone Graft 1st or not | 1 | 9 Exfoliating | Implant Supports Bone Graft | Prevent Buccal Plate Collapse | |||
Why Not Immediate | Infection Source | 9 Root Tip Resorption | Temporary Abutment | PRF and Allograft for Repair | Ortho | ||
Atrophic Crest at Lateral | 1 Piece/Onlay Graft | 2.5 mm 1 Piece | 8 Subgingival Frature | Several Missing Back Teeth | Trajectory Check | ||
Severe Bone Loss | Which 1st: | Graft or Implant F-U | Ku | 9 Large Periradicular Radiolucency | Nasal Floor/Incisive Foramen | 3.8x15 mm Close to Nasal Floor | |
Loss of Labial Plate | Where to Graft? | How to Close Fistula | 10,12 Narrow Ridge | Guide for 1-Piece Implants? | |||
Hardship of Delayed .. | Oblique Trajectory | 8/9 Cantilever FPD | Narrow Dense Bone | Right on the Target | |||
Labioincisal Shift, Occlusal Trauma | Easier, Re-treatable | Periimplant 2 Redo Design | 7 Residual Roots, 87 y/o Lady | 2.5 mm 1 Piece; Socket Shield | Palatal Osteotomy | ||
Malposition with Delayed .. | Design | What is wrong? | 10 Fractures against Implant-supported | Temporary | Emergency Immediate | ||
Limited Vertical Height | Deep Placement | Adjust Position | Periimplant 2 | 8,9 Buccal Plate Loss | Free Hand Immediate | PRF/Sticky Bone for Soft/Hard Defects | Bone Graft |
Narrow Ridge at Lateral | Approaches | 9 Equigingial Fracture | Bruxism | Palatal Osteotomy | |||
Labial, Incisal Drifting | Abutments | Buccal Gap Closure | 7 Fracture | Related to Class V Defect | Repair Apical Buccal Defect | ||
Early Implants | Expansion Initially | Placed as Immediate | 9,10 Residual Roots | Cantilever FPD | Depth 1st | ||
Deviation of Root | How to Correct it? | 10 Labial Concavity | 2.5 mm 1-Piece Implant | External Fixation | |||
Bruxism | Limited Vertical Ht | Osteotomy Adjust. | 7 Equigingival Fracture | Lower RPD | Aborted Shield | ||
Central Fractures | Equigingival | Epinephrine | |||||
Female Senior, Osteoporosis | Under Prep | 9,31 Prevent Periimplantitis | 9 Crown instead of Implant | ||||
Male with Brain | Tumor Surgery | Osteoporosis | 9 Post Fracture, Bruxer | ||||
From FPD to Single Units | Metronidazole Study | Rebuild Buccal Plate | #10 Residual Root | Socket Shield | |||
Atrophic Buccal Plate of #9 | Palatal Placement | Edge to Edge | Normal Bite | Tooth Fracture Post RCT | 2-Step Grafting | ||
Atrophic Crests: #7-10 | 1 Piece Implants | Heal | Atrophic Lateral Site | Angled 1-Piece Implant | |||
Long Root Low Density Bone | Long Implant | 1-Piece Delayed | 9 Crown Fracture | Bruxism, Deep Bite | |||
Post-Ext | Buccal Plate Collapse | D implant | 9 Heavy Occlusion Deep Bite | ||||
RPD Anchor Tooth Fracture | Senior Osteoporosis | Long Implant | #7 Perio Abscess Post Lower | Quadrant SRP | |||
Central Root Fracture | Preop PA | Cemento-Enamel Junction | 9 Unilateral Mastication | Bruxer | |||
Chronic Periodontitis | Acute Episode, | Immediate Placement | RPD | 9 10 Buccal Placement | Redo with Guide | ||
Long Term Trauma to #8,9 | Narrow Implants | Temporary Abutments | 10 1-piece implant with | 1.5 mm Bone on Either Side | |||
Central Root Fracture | Preop PA | Cemento-Enamel Junction | 7-9 Fractured FPD | Angled Abutments | Socket Shield | ||
Subgingival Fracture | Senior Lady | Underprep, UF | Early Regraft | #8-13 One piece Implants | #8 Implant Fractures | ||
Failed Bridge | Pre-mounted Implants | Control Implant Depth | 10 Thin Bone | Onlay Graft | |||
Periodontally Displaced Central | Place Implant Deep | Clearance from Partial | 8-9 Loose Splinted Crowns | ||||
Post-Induced Root Fracture | Premature Contact | Small, Long Implant PRF | 10 Narrow Native Bone | Not So Narrow As CT Shows | |||
Extruded Lateral | Repair Buccal Plate | Repair Defect Before Implant | 6 Large Gingival Embrasure | Temporary Abutment | |||
Possible Palatal Plate Defect | PRF | Buccal & Palatal Defects | Redo | ||||
Fractured Fiber Post & Crown | Hollow Crown | Straight Abutment | Emax? | ||||
Extruded Central Incisor | Labial Plate Defect | Labial Margin | 8 Apico 9 Immediate |
Xin Wei, DDS, PhD, MS 1st edition 02/09/2014, last revision 07/18/2021