Dr Ilias Oikonomou
Trauma in the esthetic zone:
a multidisciplinary staged approach
by UoA School of Dentistry Postgraduate clinic
(Clinical case instructors: Asst. Prof. Vassilopoulos Spyridon, Prof. Madianos Phoebus, Clinical team: Periodontology: Asst. Prof. Vassilopoulos Spyridon, Karaiskou Maria, Oikonomou Ilias, Restorative Dentistry: Assoc. Prof. Papazoglou Efstratios, Moldovani Domna, Endodontics: Prof. Kontakiotis Evangelos, Tsatsoulis Ioannis, Oral Pathology: Assoc. Prof. Tosios Konstantinos)
Dental implants placement in the anterior maxilla is a challenging clinical procedure because of the need for high surgical and prosthetic precision and for highly aesthetic results. Guided implant placement, if performed under optimal soft and hard tissue conditions, constitutes a reliable treatment approach, by facilitating minimally invasive surgical techniques and immediate restoration of function and aesthetics.
• Case presentation
An aesthetically concerned 20-year-old woman presented with dental trauma which has resulted in horizontal root fractures of both the maxillary central incisors. She had undergone endodontic treatment and periapical surgery with retrograde filling of MTA in those teeth three years ago in our clinic due to large periapical lesions caused by a previous dental trauma. An interim prosthesis was fabricated. After thorough clinical and radiographic evaluation, a staged treatment approach was decided which included firstly the removal of both roots followed by a guided bone regeneration procedure in order to achieve a favourable hard tissue architecture. A biopsy and histological examination of the granulation tissue was then performed. Six months later, the computer assisted planning of the guided procedure was completed with the design of a surgical guide and an interim fixed prosthesis. Subsequently the surgery for the placement of two implants in the position of the maxillary central incisors was performed, during which the surgical guide was used and no surgical flaps were raised. The implants were placed in the desired position and the required primary stability was established, thus allowing for immediate provisionalization with the prefabricated temporary fixed partial denture following the one abutment- one time concept. During the next four months of follow-up, modifications of the interim prosthesis were made in order to achieve optimal results. The final prosthesis will be delivered by the end of May.
Guided implant placement has been established as a valuable treatment method in the aesthetic zone. If a staged therapeutic approach is selected, then the necessary prerequisites are often met for a flapless surgical technique and immediate provisionalization to be performed in order to ensure optimal healing, enhanced convenience and satisfactory aesthetics during the post-surgical period. During provisionalization, sufficient time is essential for optimal results regarding soft tissue maturation.