Case report: Extraction/immediate implant placement with provisional, using the Ditron Ultimate Implant System

Clinical treatment by Robert J. Miller, DDS, and Technics Laboratory

Featuring Ditron Ultimate Implant

Clinical case overview—

Patient age/gender: 72-year-old male
Chief complaint: Fracture of clinical crown tooth no. 10
Radiographic findings: Fractured lateral incisor with periapical pathology
Clinical findings: Oblique fracture no. 10 to bone level
Diagnosis: Unrestorable maxillary lateral incisor
Treatment plan: Extraction/immediate implant placement with nonfunctional provisional

Treatment notes

Figure 1: Clinical presentation of fractured maxillary lateral incisor

This patient suffers from a severe case of Guillain-Barré syndrome and has great difficulty using his forearms and hands. He presented with a subgingival fracture of no. 10, deemed to be unrestorable (figures 1 and 2). In a discussion of a bridge versus an implant, the patient desired a single-tooth replacement given his challenge in maintenance.

Figure 2: Pre-op clinical radiograph no. 10 with oblique fracture to osseous crest

The decision to use the Ditron Implant System was based on the need for extraction and immediate implant placement, with immediate provisionalization using a final titanium abutment. The Ditron Ultimate implant gives a very secure initial stability and strong abutment connection to address the need for compression of treatment time.At the initial surgical appointment, the left maxillary lateral incisor was removed, the osteotomy carefully debrided, and a Ditron Ultimate implant was placed to the ideal placement protocols (figures 3 and 4). The implant provided such favorable initial stability that I was able to place the final abutment and prepare it intraorally for the provisional restoration.

Figure 3: Postoperative clinical photograph

A final titanium solid abutment was placed (figure 5) and torqued to recommended values. The abutment was then prepared intraorally and a composite resin provisional placed out of function in all excursions.

The implant was allowed to heal for two months before impressions. The final zirconia crown was delivered two weeks later (figure 6).

Conclusion

The patient related to our office that he had absolutely no postoperative discomfort, no prosthesis complications, and was very impressed by the entire experience as he had a different outcome for his previous implant tooth replacements.

Disclosures or conflicts of interest: Dr. Miller has a financial relationship with Ditron Dental USA. Products mentioned are used in the regular course of practice.

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

Figure 6: Final restoration in the mouth

Robert J. Miller, DDS, received his B.A. from New York University and M.A. from Hofstra University, both in biology. He graduated with honors from New York University College of Dentistry in 1981, where he received the International College of Dentists Award for clinical excellence and then completed his residency at Flushing Medical Center in New York City.

Dr. Miller is a board-certified diplomate of the American Board of Oral Implantology, diplomate of the International Congress of Oral Implantologists, honored fellow of the American Academy of Implant Dentistry, fellow of the American College of Dentists and Academy of Osseointegration, and the acting chairman of the department of oral implantology at the Atlantic Coast Dental Research Clinic in Palm Beach, Florida. He is director of the Center for Advanced Aesthetic and Implant Dentistry in Delray Beach, Florida, and codirector of the Pacific Institute for Advanced Dental Education.

Dr. Miller has a full-time practice dedicated to Implant Dentistry and revision surgery and maintains an active international lecture schedule as well as being engaged in biomaterial, laser, and dental implant research.