Α technique for atraumatic root extraction, immediate implant placement and loading in maxillary aesthetic zone

Abstract

The study aims to report a technique for the extraction of an anterior maxillary root with simultaneous immediate implant placement and immediate loading with provisional non-functional restoration. Due to a root fracture of a maxillary lateral incisor (#22), a semilunar flap was utilised to create a bony window in the apical area of the tooth and gently extract the remaining portion of the root through the alveolar socket. This technique is recommended in cases of immediate implant placement in fresh extraction sites where coronal bony bridge is intact. Then an implant was placed and the apical bony defect was repaired with guided bone regeneration. The loading of the implant with a temporary implant restoration within 24 h was applied without functional occlusal contacts. The placement of the permanent restoration was scheduled for 6 months later. After 1 year, a clinical and radiographic examination showed a normal peri-implant bone level and a successful aesthetic effect. Furthermore, after four years the patient was examined and the implant is still showing good functional and aesthetic outcome. The preservation of the coronal bony anatomy, periosteum and soft tissues during the immediate implant placement is a major contributing factor to a desired aesthetic effect, which is enhanced with the option of immediate non-functional loading. The described surgical approach preserves the advantages of immediate implant placement in fresh extraction sites in the maxillary aesthetic zone without intrasulcular incision and mucoperiosteal flap elevation while minimising the bony injuries during the extraction of the tooth.