1) A 20-year-old female patient wanted to replace her missing lower right back tooth that was extracted 4.5 months prior due to decay. 2) A clinical and radiographic examination found sufficient bone height and width for a 4.6 x 9 mm dental implant. 3) The patient underwent implant placement surgery using a two-stage technique and healed uneventfully. 4) After 3 months of healing, a gingival former was placed at the second stage surgery. 5) An abutment and crown were fabricated using an indirect impression technique and cemented to complete the treatment.

1. Single Tooth Implant
Placement
Presented by
Dr. Shalin khatri

2. Case Study
Patient Name – Vandana Shingare
Age - 20 yrs
Sex - Female
Marital Status - Married
Occupation - Employed

3. Chief Complaint
Patient wants to replace her missing tooth in lower right
back region of mouth.

4. History
 Extraction of tooth right side 4 and half months back.
 Extraction was uneventful on right side.
 Reason for extraction was tooth decayed.

5. Medical & Dental History
No h/o of DM/HTN/TB/Bleeding disorders.
No h/o of hospitalization last 6 months.
No h/o regular intake of medication for any systemic illness.
She has visited dental college few times for restorations and extractions of the same missing
teeth.
She uses a tooth brush and paste to brush her teeth once a day.
She does not use any other oral hygiene aids.
she has mixed diet.

6. General Physical examination
An adolescent well built, moderately nourished female well oriented to time place and person.
Gait unaltered.
Facial examination
No deviation of mandible on opening and closing.
No clicking sounds.
No regional lymphadenopathy.

7. Clinical Evaluation of Implant Site
Space Evaluation –
Mesio – Distal length – 10 mm
Bucco – Lingual Width – 7 mm
Occlusal Height - 10 mm
Radiographic Evaluation –
Available Bone Height – 11.5 mm

8. Treatment Options
Removable partial denture
Tooth retained fixed prosthesis (Dental Bridge)
Screw retained fixed prosthesis (Dental Implant)
Patient was willing for Implant in 46 region

9. Treatment Plan
According to clinical and radiographic evaluation, root form endosteal
implant 4.6 x 9 mm planned for 46 region.
Two stage surgical technique planned.
Indirect technique for implant impression.

10. Procedure
(1) Incision
Crestal Incision was made, at mid crestal region
Coronal incision given on buccal aspect to increase visibility and
instrumentation.
Periosteal elevator used for soft tissue reflection.

11. (2) Implant Osteotomy –
 A round bur was used for dimple preparation (center of M-D, B-L area) at planned
osteotomy site.
 2 mm diameter end cutting bur (Pilot drill) used to start drill up to half of the length.
 Guide pin placed in osteotomy and radiograph taken to check location, angulation and
distance from nearest anatomical landmark (Adjacent teeth & Mandibular Canal).

12.  Osteotomy depth to 9 mm from the crest was made.
 800 RPM speed and 40 Nm torque used for drilling with saline.
 A 2.5 mm drilling bur is used up to 9 mm.
 Sequential drilling done by side cutting twist drilling bur.
 4.6 x 9 mm Implant placement was done into the final osteotomy site with hand
driven torque control ratchet.
 35 nm torque used for primary stability of implant.
 Radiograph was taken to verify the final position
of the implant.
 Cover screw placed over implant.

13. Tension free interrupted sutures given.
Recall the patient after 10 days for suture removal.

14. (3) SECOND STAGE SURGERY
 After 3 months, patient recalled for second stage
surgery.
 Infiltration anesthesia given buccally and lingually.
 Slight lingual incision given and flap raised.
 A 5 mm collar height gingival former placed on
implant body.
 Suture the tissue around gingival former.

15. (4) Prosthetic Phase
Remove healing collar and check gingival healing.
3 mm gingival cuff was formed around the crest module/shoulder.
A transfer coping placed over implant body to transfer implant location and
angulation on cast.
Closed tray indirect impression technique used and impression made with putty
and light body.
Lab analog placed on transfer coping and impression was sent to lab for crown and
abutment preparation.
Gingival former replaced on implant body.

16. Transfer Coping Placement

17. Recalled patient after fabrication of crown.
Abutment placed on implant body and initial screw tightening done with hex.
After Crown trial, final abutment tightening done.
Key hole of abutment covered with cotton and composite.
Final cementation of crown done with zinc phosphate cement.
Extra amount of cement removed with help of instrument and
dental floss.
Final radiograph taken to check crown seating on abutment and
presence of cement below the crown.
Post cementation and implant maintenance instructions given
to patient.

18. Abutment radiograph Post cementation Radiograph

19. Instructions
Soft diet for few days.
Then move on semisolid and normal diet.
Flossing and brushing techniques.
Oral hygiene maintenance procedures.
Routine check-up after every 3 months up to one year.

20. Before Treatment
After Treatment

21. Thank you