The document summarizes the immediate placement of an implant to replace a missing tooth for a 36-year old female patient. It describes the clinical evaluation, treatment plan of extracting the remaining root and immediately placing an implant. It then details the surgical procedure, placement of bone graft and membrane. After 3 months of healing, the second stage surgery is done to uncover the implant for a gingival former and eventual abutment. An impression is taken and crown fabricated and cemented, with instructions given to the patient for implant maintenance.

1. Immediate Placement
Dr Sanjay Bhikaji Sawant

2. Content
1 Implant Anatomy
2 Patient Details
3 Chief Complaint
4 Patient History & Examination
5 Treatment Options
6 Clinical Evaluation of Implant Site
7 Treatment Plan
8 Implant Procedure
9 Patient Instruction
10 Implant Maintenance
11 Pre & Post Treatment

4. Patient Name Mrs Pooja
Sutar
Age 36 years
Sex Female
Mariatal Status Married
Occupation Housewife

5. Patient wants to replace her broken
tooth in the upper right tooth region

6. Past Dental History
1 Extraction of lower right first molar two years back
2 Copmposite Restoration with 11 ,21 and 22

7. No relevant past and present Medical
History Reported By Patient

11. Extraction of root pieces of 14 planned followed by
immediate placement of Implant

12. Pre-operative Root-piece of Upper
Right First Premolar

13. Occlusal View Pre-Operative

14. SPACE EVALUATION
Mesio-distal Dimension 8 mm
Bucco-lingual Dimension 7 mm
Inter-Occlusal Distance 5 mm
RadioGraphic Evaluation
Bone Height 15 mm

15. According to clinical and radiographic evaluation, root
form endosteal implant 3.8 x 12 mm planned for 14 region.
Atraumatic Extraction Of Root Piece of 14 followed by
placement of Implant followed by filling of jumping gap with
Bone Graft covered B Membrane.
Two Stage Surgical Technique planed followed by closed tray
impression technique for prosthesis.

18. Local Anaesthesia Buccal and Palatal Infiltration Given
No.15 Blade is used around crevicular area of Root Piece . Sequential Use
Of Periotome is used as per Concept of Atraumatic Extraction Technique .

21. After Removal Of Root piece Piolet Drill used with length of 12
mm followed by X-Ray to confirm Angulation .
Osteotomy is further widened by 2.5 mm and 3.2 mm
diameter Drill with length 12 mm.
Implant of 3.8 mm Diameter length 12 mm inserted in
osteotomy site . Final torque of 35-40 N-cm used .

22. Atraumatic Extraction Technique
Pericision
Apllication of Elevators and
periotomes
Forcep application
Socket Debridment
Socket Inspection

24. Bone Graft (Nova-Bone Putty ) is firmly
packed to fill all the jumping gap ,
followed by copmlete coverage of graft by
Resorbable Collagen Membrane followed
by tension free water tight interrepted
sutures to close the site .Healing Cap
Placed.
Post-Operative IOPA taken

27. PROSTHETIC PHASE
 Second Stage Surgery
 Patient was recalled after 3 Months
 Infiltration administered
 Inspectd for any soft or hard tissue adverse changes occurred .
 Remote crestal incision given with need to expose cover screw .
 Irrigation with Betadine Done at cover Screw Region .
 Cover Screw Is removed with the aid of Hex driver
 Gingival Former / Healing Abutment is selected as per criteria .
 Gingival former placed confirmed fitting in IOPA .
 Sutures placed
 Post-op instruction and medication prescribed .

28. Impression Making
 Patient Recalled after 15 days .
 Inspected for any Soft or Hard tissue unwanted Changes .
 Gingival Former is removed with the aid of Hex Driver .
 Abutment is selected as per criteria .
 Abutment is seated on Fixture and proper tight joint confirmed
in X-Ray .
 On confirmation abutment removed and replaced by Transfer
Abutment Coping .
 Closed Tray Impression Technique selected .
 3M Express XT2 VPS Soft Putty And Light Body Impression
Material Chosen .

29.  Appropriate Tray Size Selected .
 Soft Putty is Mixed In Hand Simultaneously assistant
dries area of impression and light body with aid of gun
is loaded over area of interest . Putty Mixed loaded in
tray and placed in mouth .
 Once Impression Material Set it is removed .
 Impression removed from Mouth .
 Transfer coping is removed from mouth and seated in
tray .Click noise confirmed .
 Implant analogue is seated in coping and whole
assembly send to the lab for further Prosthesis
Fabrication .
 Healing screw placed in Mouth
 OHI given to patient .

31. Well Formed Gingival Cuff By Gingival Former

32. Abutment Fitting Checked In X-Ray

33. Crown On Cast Facial View Crown On Cast Lingual View

34. Mesio-Distal fit of Crown Facial View Of Crown

35. Final Crown Cemented . Any Residual Extra
Cement is not remained is confirmed in X-
Ray

36. Patient Instruction

37. Implant Maintaince

38. Pre-Treatment Post-Treatment

40. Thanks For Going Through
Dr Sanjay Bhikaji
Sawant