IMMEDIATE SINGLE IMPLANT PLACEMENT WITH IMMEDIATE LOADING IN THE MAXILLA

Abstract

The primary aim of this article is to present a comprehensive clinical case report regarding immediate single-implant placement combined with an immediate loading protocol in the maxillary premolar region. This modern surgical approach was utilized to provide a rapid, high-quality aesthetic and functional solution for a patient following the sudden loss of the maxillary left first premolar. The case involved a 45-year-old healthy female patient who sought treatment after sustaining trauma-related damage to the tooth. Upon detailed intraoral examination and radiographic assessment, a non-restorable root remnant associated with tooth 24 was identified, necessitating a strategic extraction and replacement plan.
The surgical phase began with a minimally invasive, atraumatic extraction of the root remnant to ensure the maximum preservation of the surrounding alveolar bone and delicate gingival architecture. On the same day, a dental implant was successfully placed into the fresh extraction socket. To manage the residual space, known as the "jumping distance," between the implant surface and the internal walls of the socket, a bovine-derived xenograft (Bio-Oss) was meticulously packed into the gap. Notably, this was performed without the use of a barrier membrane; this specific technique was chosen to allow the periosteum to remain in direct contact with the graft, thereby maintaining its vital role in providing vascularization and essential growth factors to the site.
To meet the patient's immediate aesthetic demands and to help mold the peri-implant soft tissues, an immediate provisionalization was carried out using a custom-made PMMA temporary crown. This temporary restoration allowed for the maintenance of the emergence profile throughout the integration phase. Following an undisturbed five-month healing and osseointegration period, the digital restorative phase was initiated. A final implant-level digital scan was obtained using the high-precision CEREC Primescan system, ensuring an accurate recording of the soft tissue contours and implant position.
Subsequently, a definitive zirconia crown was fabricated and mounted on a titanium base (Ti-base) to provide long-term durability and biocompatibility. The restoration was carefully seated and occlusion was verified. This case report clearly shows highly aesthetic and functional results. Furthermore, it highlights several clinical advantages of this protocol, including the elimination of a secondary surgical site, a significantly reduced overall treatment duration, and the preservation of the natural alveolar ridge volume and gingival aesthetics.