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My patient had a tooth in his lower right side, the first molar, that was very mobile due to advanced gum disease with severe bone loss. The tooth was deemed hopeless in prognosis, so I recommended the patient have the tooth extracted. The patient has presented the different options with the would-be space left behind in detail: leaving the space empty, replacing it with a removable partial denture, fixing a three-unit-dental bridge, and placing a crown supporting by an implant. After all the fees, procedures and other questions were answered, the patient elected to have the tooth removed and replaced with an implant-supported crown.

Severe bone loss in the first molar
1. Severe bone loss in the first molar

After having a cone-beam computed tomography taken (CBCT) to determine the adequacy of bone volume and quality for an implant, treatment plans were made to place a tissue level Biohorizons implant immediately after the extraction using a surgical template to guide the placement of the implant.

Treatment planning using 3D imaging
2. Treatment planning using 3D imaging

The patient was instructed to take an antibiotic and rinse his mouth with an antiseptic for a few days before the surgery.

On the day of surgery, a local anesthetic was first administered, and when the numbing was profound enough, the tooth was atraumatically extracted. The inflamed tissues inside the socket were cleaned out carefully and meticulously. Immediately, an implant was placed inside the prepared socket. Due to severe bone loss from his advanced gum disease, ground bone particles from a human donor were grafted and packed around the implant. A special collagen membrane was placed over the bone graft to ensure that the patient’s bone cells migrated among the bone graft particles to form new natural solid bone around the implant.

Immediately implant and bone graft placement after the extraction.
3. Immediately implant and bone graft placement after the extraction.
An implant case
4. The implant with a cover after six months of healing.

After six months of healing, a resonance test, a device that gives out a measurement in number, was done to determine how well the implant had been embedded in the jaw bone. The measurement indicated a well-integrated implant with the bone; therefore, the implant was ready to support a crown. A Trois digital scanner was used to take an impression of the teeth and implant. The digital data were sent to a dental laboratory. A digital model was printed with the implant analogue embedded in it in the same way as the actual implant in the month.

A crown made with Zirconia material was made that fit onto the implant. The crown was then secured to the implant with a screw in the mouth that must be tightened with a torque wrench.

After the crown was securely screwed onto the implant, a composite resin was used to fill in the screw hole. In this case, it is a screw-retained crown. A screw-retained crown is desirable because of its ability to be removed easily from the implant if the crown is chipped and requires removal for repairs. If there is periimplantitis (bone loss around the implant due to infection), the crown must be removed for proper treatments.

The implant without the cover.
5. The implant without the cover.
The crown was made on the digitally printed model.
6. The crown was made on the digitally printed model.
The crown was tightened onto the implant with a special wrench.
7. The crown was tightened onto the implant with a special wrench.
The crown was secured onto the implant and became functional.
8. The crown was secured onto the implant and became functional.
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