Clinical Case Reports Of Implant Immediate Restoration In The Aesthetic Zone

Background:Because of its two main advantages including not injuring adjacent teeth tissues and providing functions closed to the natural tooth, dental implantation has become the best therapy in dental arch defection and absent, thus welcomed by more and more people. However, conventional implantation undergoes a long treatment cycle and complicated procedures, which to some extent affect the patients’ acceptance of implant therapy. Especially in the aesthetic zone, toothless state and removable transition denture affect patients’ a ppearance and pronunciation, bringing inconvenience to their social life. With the development of dental implantation and people’s emphasis on teeth beauty, requirements for aesthetic restoration are expanding, thus being a hot research topic, immediate implant restoration has been continuously developing and maturating. On the basis of guaranteeing the success rate of implantation, this technique not only shortens the patients’ toothless period, but also increases aesthetic effects by supporting and shaping the soft tissue around the implant with the provisional prosthesis.Immediate restoration refers to the insertion of a restoration within 48 hours of implant placement but not in occlusion with the opposing dentition, instantly restore the beauty in toothless zone, when the osseointegration is acquired, the permanent restoration are completed by replacing the upper structure. Although the rationale for the classic implant osseointegration is to keep the implant in an undisturbed environment during the healing period about 3 ~ 6 months, ensuring osseointegration between the implant and the bone. However, studies have demonstrated that immediate restoration will not lead to fibrous encapsulation at the implant–bone surface and that osseointegration can be achieved as long as the micromovement is in a good control within a certain range. However, the standard of implant success for aesthetic zone is not only to guarantee the implant survival, but also to restore the beauty of peri-implant soft tissue. In recent years, many clinical reports also showed immediate restoration had similar success rate with delayed restoration, but that there were risks for gingival recession and marginal bone loss. Therefore, not all of the patients shorten the toothless period as well as get long-term stability and ideal aesthetic effect by the application of immediate restoration.Objective: The aim of this clinical research is to evaluate the clinical effects of immediate restoration of implants placed in the aesthetic zone through the application of advanced and reliable methods, to discusses the precautions when using the immediate restoration in the aesthetic zone, and to summarize the clinical experiences of obtaining good aesthetic effect, providing the reference to help us exert the advantages of immediate restoration in the field of implantation.Methods: We selected 6 patients from the implant center in Dalian Stomatological Hospital since 2014, they were people with dental arch defection or absent in aesthetic zone asking for implant restoration. After the implant placement, vertical screw-retained provisional prosthesist was adopted in immediate restoration. The patients were asked to go for check-up regularly, during these appointments, implant mobility, oral hygiene, occlusion and peri-implant hard and soft tissue were evaluated, and corresponding actions were taken. When osseointegration were stable and soft tissue was well shaped and stable, a customized impression copying the reformed emergence profile was taken, and customized zirconia abutment and all-ceramic crown were fabricated to complete the permanent restoration for single implant or multiple implants. We replaced the provisional prosthesis with a metal acrylic resin, implant-supported fixed prosthesis with a CAD/CAM titanium framework for All-on-4 implants.Results: Implants were placed in these 7 patients with immediate restoration. After 7 to 12 months’ clinical observation, all implants had obtained good osseointegration and had no pathological bone resorption, as well as playing a good function. All patients were satisfied with the outcomes. Whereas the aesthetic effect was presented differently among individuals, 4 cases’ aesthetic effects were remarkable, and others’ aesthetic effects were not good.Conclusion: With accurate assessment of patients involving systemic and local situation preoperatively, rigorous operation and judgment intraoperatively, and proper means of restoration postoperatively, immediate restoration in the aesthetic zone can give full play to its value and obtain ideal clinical effect.