Single visit replacement of failing maxillary central incisor

A 24 year-old female patient presented with pain and previous episodes of swelling in the region of endodontically treated tooth #21 FDI (#9 US). During clinical examination mobility of tooth #21 FDI (#9 US) was noticed. After clinical examination and radiographic analysis the patient was diagnosed with fracture of the maxillary left central incisor. Immediate implant placement was selected as the treatment of choice for this situation.

Minimally traumatic extraction of tooth #21 FDI (#9 US) was performed. A tapered implant was inserted into the post- extraction socket without raising a flap. Bone graft was placed between the implant and buccal bony wall, and a healing abutment was hand tightened. Despite achieving high insertion torque of more than 35 Ncm, an immediate restoration was not placed due to an unfavorable occlusal relationship (deep vertical overlap). The crown of the extracted tooth was separated from the root and bonded to neighboring teeth using glass reinforced fibre and previously fabricated silicone guide.

Four months later, a provisional restoration was placed. After two months of soft tissue healing, an emergence profile impression was made for fabrication of a definitive crown. An angulated screw channel abutment was chosen because the screw access hole was located at the incisal edge.

After 4 years of follow-up, stable interproximal bone levels are observed on a radiograph. Stable papilla levels and marginal gingival level were observed clinically while slight oro-facial volume loss was present. However, there was an incisal edge discrepancy present between the implant restoration and contralateral central incisor after 3 years. No other technical nor biological complications were noticed during the follow- up period.

Immediate implant placement in the esthetic zone can provide favorable results in terms of function and esthetics with stable gingival margin and papilla levels. Angulated screw channel abutments allow the clinician to use a a screw retained restoration. However, eruption of adjacent maxillary anterior teeth can continue in adulthood and results in an incisal edge discrepancy between the single implant restoration and neighboring teeth.