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Inside Dentistry
February 2023
Volume 19, Issue 2
Peer-Reviewed

Immediate Dental Implants for Anterior Tooth Replacement in Older Patients

A case review with 5-year follow-up

Jeffrey Lineberry, DDS

Despite the significant advancement of dental restorative procedures, tooth loss still occurs for a variety of reasons within our patient populations. The natural process of aging is one of many factors that has an impact on overall tooth loss, both directly and indirectly. When older patients are faced with tooth loss, one of the many questions and considerations involved is whether or not to replace the lost tooth, and if it is to be replaced, what treatment approach will be used to replace it. Nowadays, patients are living longer and staying healthier well into their eighties, and they are demanding esthetic, fixed restorative solutions.

A 78-year-old female patient presented to the practice for an emergency visit because her left lateral incisor (tooth No. 10) had fractured at the gumline. She reported that she was "simply biting into a sandwich when her tooth broke off." The patient had a long history of consistent dental care throughout her life, and more than 30 years ago, tooth No. 10 had been previously restored with a root canal treatment, post and core buildup, and a porcelain-fused-to-metal (PFM) crown. Upon examination, it was noted that tooth No. 10 was fractured with no coronal tooth structure left and that a vertical root fracture was present. The tooth was deemed non-restorable. Treatment options were presented to the patient, and the risks and benefits of an implant-supported restoration versus a fixed partial bridge were discussed. If possible, the patient decided that she would like an implant placed. Her fractured PFM with its intact post and core was temporarily re-cemented that day and the patient was appointed to return for records.

About the Author

Jeffrey Lineberry, DDS
Fellow
Academy of General Dentistry
Fellow
International Congress of Oral Implantologists
Accredited Member
American Academy of Cosmetic Dentistry
Private Practice
Mooresville, North Carolina

A cone-beam computed tomography (CBCT) scan was acquired of the tooth No. 10 site.

Figure 1

Preoperative smile photograph.

Figure 2

Preoperative left lateral smile photograph.

Figure 3

Preoperative retracted photograph with the teeth apart.

Figure 4

Preoperative close-up and left lateral close-up photographs of tooth No. 10.

Figure 5

Preoperative close-up and left lateral close-up photographs of tooth No. 10.

Figure 6

Using dental implant planning software (Simplant®, Dentsply Sirona), a 3.0 mm × 13 mm implant (NobelActive®, Nobel Biocare) was planned to replace tooth No. 10. During the preoperative planning, it was noted that, due to a significant gap between the facial bony plate and the implant, bone graft would be needed. In addition, the decision was made to fabricate a removable, “flipper” type restoration for the patient to have a tooth replacement during healing.

Figure 7

On the day of surgery, tooth No. 10 was atraumatically extracted, and the facial bony plate was kept intact. Utilizing a surgical guide to ensure accurate placement, an osteotomy was performed, and the implant was placed into the extraction site and torqued until primary stability was achieved (35 Ncm). Bone graft material was inserted into the extraction site between the implant and the facial plate of bone, and a cover screw was placed.

Figure 8

Postoperative retracted photograph of the flipper restoration, which was delivered and adjusted to avoid pressure in the area of the implant during healing. The patient was seen for regular follow-up visits and healed without complications. Approximately 3 months after extraction and implant placement, a second surgery was completed to expose the implant, a healing abutment was placed, and the flipper restoration was adjusted accordingly.

Figure 9

The patient returned approximately three weeks later, an impression post was placed, and a final impression was acquired.

Figure 10

Posttreatment smile photograph and close-up and left lateral close-up photographs of tooth No. 10, which was restored with a custom abutment and a lithium disilicate crown that was cemented into place due to the overall size of the access relative to the final restoration. The patient stated that she was very happy with the outcome.

Figure 11

Posttreatment smile photograph and close-up and left lateral close-up photographs of tooth No. 10, which was restored with a custom abutment and a lithium disilicate crown that was cemented into place due to the overall size of the access relative to the final restoration. The patient stated that she was very happy with the outcome.

Figure 12

Posttreatment smile photograph and close-up and left lateral close-up photographs of tooth No. 10, which was restored with a custom abutment and a lithium disilicate crown that was cemented into place due to the overall size of the access relative to the final restoration. The patient stated that she was very happy with the outcome.

Figure 13

Five-year posttreatment smile photograph and close-up and left lateral close-up photographs of tooth No. 10.

Figure 14

Five-year posttreatment smile photograph and close-up and left lateral close-up photographs of tooth No. 10.

Figure 15

Five-year posttreatment smile photograph and close-up and left lateral close-up photographs of tooth No. 10.

Figure 16

Five-year postoperative CBCT scans demonstrating the long-term healing achieved.

Figure 17

Five-year postoperative CBCT scans demonstrating the long-term healing achieved.

Figure 18

A comparison of the immediate postoperative and 5-year postoperative left lateral close-up photographs demonstrates how dental implants can provide a long-lasting, stable solution, even in older patients.

Figure 19

Jeffrey Lineberry, DDS

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