Full-Digital Workflow for immediate loading of post-extractive single-tooth implant

OBJECTIVES This article describes the clinical case of a patient with a chronic lesion associated with element 2.5, treated with an immediate post-extractive implant rehabilitation. MATERIALS AND METHODS The patient presents element 2.5 considered hopeless with vestibular fistula, with no acute symptoms; therefore, she underwent a procedure of immediate loading of post-extractive single-tooth implant, using static guided surgery and management of hard and soft tissues. An intra-oral scan and a CBCT were acquired to design implant-prosthetic placement and surgical template. Matching DICOM files and scanning files allows the creation of a virtual patient in which to define the prosthetic and surgical-implant project. It is verified that the residual bone volumes are suitable to reproduce the pre-existing anatomy and allow the correct implant placement. In the first surgical step, we proceed to atraumatic avulsion of element 2.5; then, after placing the surgical template, we proceed to the preparation of the implant site and insertion of PSK Regular implant produced by Oxy Implant, Colico, Lecco, Italy. At the end of this phase, the soft tissue management procedures are performed, with epithelium-connective epithelial-connective tissue graft harvested from the palate, and, once disepithelized in extra oral, sutured inside the multipapillary vestibular flap with coronal advancement. Then, we performed the Alveolar Ridge Preservation (ARP) by inserting a 90% deproteinized bovine bone sponge and 10% collagen soaked in viscoelastic collagen gel enriched with glycopeptides inside the residual alveolar space. Finally, it is possible to immediately insert the prosthesis on the implant, with internal hexagonal connection abutment and screwed crown. The 1-year follow-up shows normotrophic and normochromatic peri-implant tissues. X-rays after one and two years show optimal osteointegration of the implant in position 2.5. RESULTS AND CONCLUSIONS The virtual planning of a prosthetically guided surgical approach of an immediate post-extractive single implant has led to an excellent management of this clinical case in terms of aesthetics and function, clinically and radiographically confirmed with follow-up up to 1 and 2 years. CLINICAL SIGNIFICANCE The guided surgery of a post-extractive implant, combined with an immediate prosthesis and proper management of hard and soft tissues allows high levels of precision in respect of biology and lower incidence of intra and post-operative complications.