Management of Unscheduled Anterior Tooth or Prosthesis Loss With Extraction and Immediate Implant Placement: A Clinical Report

Immediate treatment to manage an unscheduled patient esthetic crisis following an anterior tooth, crown, or prosthesis loss is important. The immediate management of the anterior esthetic crisis allows for definitive treatment at a separate appointment. Following initial esthetic management, the hopeless tooth or teeth can be replaced with definitive implant prosthetic treatment a short time later on an appointment basis. Most esthetic anterior tooth replacement is done with a delayed surgical implant protocol. This delay can result in loss of both soft and hard oral tissues during the healing period, necessitating soft tissue and bone augmentation procedures, including surgical bone expansion, guided tissue regeneration, bone block grafting procedures, or a combination. These losses often can be avoided at the time of tooth removal with immediate implant replacement. This article demonstrates a technique for management of a patient's unscheduled prosthesis loss with traditional dental treatment and then at a separate appointment, definitive treatment using immediate implant replacement with grafting for the extracted teeth. The article further describes the diagnostic and radiographic planning for immediate implant replacement with necessary bone expansion and grafting requirements, the fixed screw retained provisional restoration which stabilizes the implants following extractions and facilitates ease of removal for treatment, and lastly the final prosthodontic restoration of the missing teeth, restoring the esthetics of the affected area.