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In Oct 2020, I wrote a blog on a case about extraction of a hopeless upper central incisor tooth and then bone grafting with mineralized freeze-dried bone allografts (FDBA).  A week ago, I placed a Straumann bone level taper implant (Roxolid SLA) in the grafted site and attached an immediate temporary crown made of polyether ether ketone (PEEK).

Before the surgery, the patient had a cone-beam computed tomography (CBCT) done to see the quality and quantity of bone at the site of the bone graft a few months ago. After witnessing enough bone and measuring the dimensions, I selected a 4.1 mm x 8 mm Straumann BLT implant for the site. With the help of sophisticated software to place the implant virtually in an ideal location with the correct orientation, a 3-D printed surgical guide was fabricated to help me insert the implant precisely in the bone the way it was planned for the surgery.

The patient started taking oral antibiotics and rinsing her mouth with Closys two days before the implant surgery. On the day of surgery, she was given anxiolytic medication to reduce her anxiety during the surgery. Astracaine 4% was used as the local anesthetic.

The existing temporary tooth pontic (bonded to the adjacent incisor with Ribbon reinforced composite resin) was removed first. The adjacent teeth were cleaned and scaled to provide a more hygienic site for the surgery.

Incisions were made so that the gums could be peeled away from the bone where the implant was going to be inserted. A drilling protocol was then performed with the surgical guide to direct the drills to the predetermined location, orientation and depth.

The resulting channel in the bone (called an osteotomy) was created using the guided surgical protocol. The Straumann implant was slowly threaded into the osteotomy to the desired depth.

A prefabricated temporary PEEK crown was attached to the implant and secured with a screw.

The gum tissues peeled off from the bone were then sutured back to cover the exposed bone and seal around the temporary crown to ensure proper healing of the surgical wound.

The temporary crown was adjusted to avoid contact with the lower opposing teeth when the patient bites her teeth together. It is vital not to place excessive and constant pressure on the implant via the attached temporary crown before it is osseointegrated.

The healing period for osseointegration is about 4 to 6 months. Until the bone has sufficiently grown into the porous spaces on the implant surface, the temporary crown will be replaced with a high-quality crown made with lithium disilicate on a titanium-based attachment. Because the current temporary crown is whiter than the patient’s surrounding teeth, the patient will have teeth whitening done to her teeth before the final crown is made.

Currently, the gum tissues at the space between the temporary crown and the canine are missing, leaving a large space between the two teeth (called a black triangle). Hopefully, the gums will fill in the area in a few months to create a nice papilla (gums between two teeth).

I will continue to update the progress of this case in my future blogs.

Figure 1: Cantilever bridge Before the implant surgery

Figure 2: After the cantilever bridge was removed

Figure 3: The immediate temporary crown attached to the Straumann implant

Figure 4: X-ray of the implant placed

Figure 5: Smile immediate after the surgery

Figure 6: A week after the surgery

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