Name: Smile rehabilitation using implant supported prosthesis

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Authors: Anand Narvekar, Parag Khatri and Manoj Garg

Endosseous dental implant therapy is rapidly becoming the prosthetic standard of care for a vast array of clinical applications; however, despite the high success rate of endosseous implant therapy, it has yet to achieve wide public acceptance and utilization [1].

Endosseous implant therapy in the mandible (parasymphyseal mandible) has repeatedly been reported at a success rate of 95% or better, yet public utilization of endosseous implant therapy has not exceeded 5%. An obvious area of focus has been to decrease the amount of time necessary to complete implant therapy.

Approaches to achieve this goal have dominated clinical research and practice, immediate implant loading, improving implant surface technology (promotion of quicker healing and better osseointegration), and immediate placement of an endosseous implant after extraction of a natural tooth are some of them.

Immediate implants have become widely accepted despite controversial beginnings but the available literature consistently cites high levels of success (ranging from 94 to 100% on average), immediate implants provide clinically recognizable benefits. Broadly speaking, these benefits include reduction of morbidity, reduction of alveolar bone resorption (controlled clinical studies have demonstrated an average of 4.4mm of horizontal and 1.2mm of vertical bone resorption 6 months after tooth extraction), preservation of gingival tissues, preservation of the papilla in the esthetic zone, and reduction of treatment cost and time (the healing phase is shorter in general and there is a reduction in the number of procedures).

With the extraction socket as a guide, the surgeon can also more easily determine the appropriate parallelism and alignment relative to the adjacent and opposing residual dentition. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material.

Primary stability is an essential requirement, and is achieved with an implant exceeding the alveolar apex by 3-5mm, or by placing an implant of greater diameter than the remnant alveolus. Esthetic emergence in the anterior zone is achieved by 1-3mm sub-crest implantation.

Patients may suffer real or perceived detrimental effects following the loss of one or more teeth. Psychological effects range from minimal to neuroticism. Tooth loss contributes to loss of confidence, avoidance of laughing in public, reluctance to form close relationship, especially when anterior teeth are missing.

Present case reports the immediate esthetic rehabilitation of mandibular anterior teeth followed by extraction with preservation of soft and hard tissue architecture.

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