#14 Immediate Placement with Immediate Loading of IT Fixture

 

Case Summary 🔎

Patient Information

Chief Complaint(C.C): Upper right side feels sore when chewing, and it doesn’t seem to hold any pressure.
Diagnosis: Caries under #14 crown & positive percussion response (++)

Treatment Plan

Extraction of tooth #14

Bone graft
Immediate placement of a Ø4.5mm implant
Immediate loading using Magic i temp

Results

Extraction of #14 was performed due to subgingival and root caries.
#14 Immediate placement & Immediate loading
Implant size: IT-III Ø4.5x11mm / G.collar 1.8mm
Bone density : D333(C3M3I3)
ITV : 40N

ISTV : 87

Case Presentation

1️⃣ Pre-Op

Pre-Op X-ray & Intraoral Photo

2️⃣ Surgery

1) #14 extraction

The internal structure of the crown has decayed, resulting in a separation from the post. To preserve the papilla, the periodontal ligament was severed using an explorer, followed by extraction.

2) Drilling protocol

fig 1. After extraction, the implant position was determined with Point Initial drilling.
fig 2, 3. Undersize drilling was performed using drills ranging from Ø2.2 to Ø4.0, and after Ø2.2 drilling. The bone density determined through Ø2.2 drilling is classified as D333, indicating soft bone.
fig 4. Pre-tapping was conducted with a Ø4.5 size Maxy drill, matching the diameter of the fixture, prior to placement.

3) Implant placement: Immediate placement

After pre-tapping with a Maxy drill, an IT-III Ø4.5x11mm implant with a G.collar height of 1.8mm was placed.
The fixture was placed precisely at the pre-tapped location, achieving a stability of 40 N/cm. For optimal aesthetics, it was positioned 3 mm below the gingiva.
With an initial torque value (ITV) of 40 N/cm and an implant stability test value (ISTV) of 87 using Anycheck, immediate loading was successfully performed.

4) Bone graft

After connecting the IT abutment, alveolar bone grafting was performed using Neo bone (allograft).

3️⃣ Temporary Prosthetics: Immediate loading

Immediate loading with uncured resin implant crown using Magic i Temp, followed by final polishing and then tightened to 30N.

4️⃣ Final Intraoral Photo

After occlusal adjustment, the hole was sealed with Teflon tape and resin to complete the procedure.

5️⃣ Clinical Video