Clinical Case Reports Of Immediate Implant In Maxillary Anterior Esthetic Zone

Objective: Through the collection and analysis of the cases using immediate implant to repair the maxillary anterior teeth in aesthetic area,combining with the literature,this article is mainly to discuss the repair design,clinical operation and repair effect,sum up experience and defects,and provide some clinical reference for the immediate implant in aesthetic area.Methods: Totally 6 patients who received the treatment of immediate implant in the maxillary anterior aesthetic area in Dalian Stomatological Hospital from April 2016 to March 2017 were enrolled in this study.The oral examination was performed routinely to check whether the periodontal tissues were abnormal and the space for repair was adequate.We took the CBCT(Cone Beam Computer Tomography)for the patients to see the remnants of the roots,to measure the available bone height,bone width and bone mineral density.We also took preoperative assessment of aesthetics risk for patients and made full communication with patients.The blood test was done before the operation,the same as the blood pressure and liver function.The patients were informed of the treatment plan,the risk,and the cost of the treatment before signing the informed consent.After tooth extraction,the implant was inserted immediately.We chose the bone augmentation surgery such as GBR(Guided Bone Regeneration)according to the situation and chose immediate or delayed restoration.The immediate restoration was taking the temporary restoration on the day of surgery to form the gingival,while the delayed needed additional 3-6 months.When we got the stability of the implant,the soft tissue had been esthetically sculpted and shaped,a final restoration was made.We followed up 1-12 months.The alveolar bone resorption,Pink Esthetic Score(PES),White Esthetic Score(WES),Papilla Index Score(PIS)and bone arch contour were evaluated.The patients’ satisfaction was evaluated by the Visual Analogue Scale(VAS),and thus the effect of the treatment was evaluated comprehensively.Results: Six patients were implanted with eight implants.All patients had been repaired permanently.After 1 to 12 months of follow-up,the implants did not fall off because of the good osseointegration and there were no obvious bone resorption.Four patients’ single implants’ PES was 8.26,WES was 8.5 and PIS(M.D)was 2.75.The other two patients’ color,texture and morphology of the gingiva around the prosthesis were well coordinated with the surrounding tissues.The fullness of the gingival papilla was acceptable.The coordination between the color of the prosthesis and the color of the adjacent teeth was better,so it was for the restoration’s contour.Six patients had a VAS of 8.5-10 with an average score of 9.17.In this paper,six patients achieved relatively satisfactory aesthetics after the treatment,and the patients were satisfied with the rehabilitative effect.However,their long-term efficacy remains to be followed up.Conclusions: The patients were followed up for 1-12 months after the repair was completed.The implants had good stability and no obvious bone resorption around.The repairing effect could meet the requirements of the patients,but there were still some shortcomings in aesthetics.Under the circumstance of strict control of indications,selecting the appropriate timing of treatment,the appropriate bone augmentation technology,the application of temporary restoration,accurate operation,immediate implant in the maxillary anterior aesthetic zone can effectively save the soft and hard tissues around the implant,and at the same time get better aesthetic results and meet the patients’ expectations to the most extent in a short term but its long-term effect remains to be seen.During the whole process of the immediate implant,from clinical admissions to post-repair reviews,the aesthetic risk assessment,imaging analysis and treatment protocol design,minimally invasive surgery in tooth extraction,three-dimensional placement of implants,selection of implants,soft and hard tissues augmentation techniques,gingival induction,accurate cuff transfer,and final restoration fabrication and insertion,each step is crucial to the acquisition of esthetics,which requires us to accumulate more theoretical knowledge and clinical experience.