Single Tooth Incisionless-Sutureless Surgery

TEETH IN A DAY

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Introduction

Immediate loading of titanium implants intended to become osseointegrated has peaked the interest of many clinicians and researchers. The evolution from the traditional 2-stage protocol, originally developed by Per Ingvar Brånemark, has provided exceptionally excellent results over the past two decades.

However, patients' desires and needs have also traditionally encouraged clinicians and researchers alike to find new solutions. Thus, acceleration of the treatment process has occurred as a result of perspective scientific studies. Much of the immediate loading research

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to a rigidly splinted multiple implant system, the majority, if not all the implants, absorb the load distribution in that system. However, any loading forces applied to a single tooth implant restoration are applied to the one implant. For this reason many clinicians believe that the initial restoration placed on the implant should be constructed in a manner that eliminates direct occlusal loading. After the implant has osseointegrated, the final prosthesis can be put into normal function. This is the procedure employed for the following patient.

Patient Treatment Review

a traumatic injury to her maxillary anterior teeth in adolescence. As a result of this injury the tooth eventually discolored from pulpal necrosis. Subsequent endodontic therapy was performed and the tooth remained clinically stable. In recent years the patient's family dentist identified external root resorption at the distal cervical region (Fig 1).

Clinical Evaluation
The patient presented with an intact dentition and significant discoloration of the maxillary right central incisor. Her smile line was graded Class IV smile line (gummy smile) making the dark coloration of the tooth obvious when she spoke and extremely evident upon smiling (Fig 2). Radiographic evaluation confirmed lateral root

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resorption and the position of proximal bone related to the resorptive process
(Fig 3). Considering the external root resorption, this tooth would have a very poor prognosis for long-term conventional restorative treatment, especially since an area of apical root resorption was also noted. Alternative forms of prosthetic intervention were discussed with the patient including the use of a 3-tooth fixed partial denture, a removable partial denture, and the possibility of a resin-bonded bridge. Ultimately, the removal of the tooth and insertion of a Brånemark implant using the TEETH IN A DAY protocol was offered. The patient felt quite strongly about maintaining the integrity of the adjacent teeth and was resistant to the thought of a removable prosthesis.
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