Immediate Implantation and Alveolar Reconstruction of Compromised Socket with Biotec Implant GMBH (IIAR)

The successful use of osseointegrated implants in the newly extracted tooth socket has been documented in numerous longitudinal studies in recent years [1,2]. However, the extent to which these positive results apply to those teeth involved with periapical lesions and/or bone plates resorption remains unclear [1,3,4]. The aim of the present case study is to show that a good diagnosis and a precise preoperative assessment help to considerable extent in the survival of our dental implants and in the future peri-implant osteo-integration [5,6] and to evaluate the ridge reconstruction outcome with autogenous bone [6,7].


Introduction
An interesting case of 52 years old female with tooth #14 extraction with reconstruction of alveolar bone and immediate implant placement in one visit. The tooth was root canal filled with periapical lesion. The buccal plate showed dehiscence and resorption which needed to be replaced by autogenous bone that we found it covering an impacted #18. All the procedures were done at the same time including tooth extraction #14, Impacted tooth removal #18, Implant placement #14, and ridge reconstruction with bone grafting.
Clinical and radiographical examinations showed a mobile crown and a labial plate fenestration with cortical bone loss + an area of periapical radiolucency at #14 (Figure 1 and 2).

Procedures
After a good pre-operative assessment, the decision was first to remove the crown of the tooth and then to remove the root with atraumatic extraction by the use of chisels and root forceps ( Figure 3).
Before the extraction, an impression of the upper and lower teeth were done and we sent it to the lab for preparation of a Maryland bridge for replacement of the tooth # 14 (with 2 wings on #13 and # 15) immediately after the extraction ( Figure 4).   Immediate Implantation and Alveolar Reconstruction of Compromised Socket with Biotec Implant GMBH (IIAR) 1092 Later on after completion of the extraction, a good enucleation of the soft tissue in the periapical area of the socket, and checking of the labial plate were done. There was labial bone loss at the middle third of the root ( Figure 5).
The post extraction pictures showed that there was no labial bone and we needed to reconstruct this bone after placement of the implant, in order to give better stability and osteo-integration for our future implant, as well as for esthetic reasons.
We used a special device to determine the amount of bone present there and the diameter of the socket ( Figure 6   Immediate Implantation and Alveolar Reconstruction of Compromised Socket with Biotec Implant GMBH (IIAR) 1093 The Biotec implant GMBH size 4.2 mm x 11.5 mm was our choice.
We started to do the pilot drill inside the socket, initially vertical and then with an angulation of 15 degrees palatally, in order to use the palatal bone and get primary stability because there was a deficient labial plate (Figure 9-12).  The placement of the implant went perfect and we got primary stability, however, there was a space between the implant and the labial soft tissue (Figure 13 and 14). So, we decided to do bone grafting and augmentation into the area.  1094 The OPG x-ray and the CT scan showed that there was an impacted #18, which needed to be extracted (Figure15 and 16). After anesthesia and removal of the impacted tooth, we used the labial bone that was covering the impacted tooth, as a graft for the missing alveolar plate in our socket (Figure 17-19). The autogenous bone was shaped according to the missing alveolar plates and was placed buccally to the implant (between the implant and the periosteum), which represents the future alveolar plate (Figure 20). We also got some chips of spongeous bone from the extraction area along with bovine bone which, mixed together and placed in the empty space (Figure 21).         Immediate Implantation and Alveolar Reconstruction of Compromised Socket with Biotec Implant GMBH (IIAR) 1097 One week later, the sutures were removed and the area was irrigated and cleaned.

Immediate Implantation and Alveolar Reconstruction of Compromised Socket with Biotec Implant GMBH (IIAR)
The Maryland Bridge was placed back and left there for exactly 12 weeks.
3 months later we continued the prosthetic protocol for the placement of the final prosthesis (Figure 27-33).    3. Autogenous bone graft still the best source of graft that we can get for ridge reconstruction.
4. Osteointegration with the use of autogenous bone graft gives faster and more ferm results than with other types of grafts. 5. Biotec Implants was our right choice for this case according to the surface topography of the implant which helps in using this implant in soft bone or in a fresh socket.