Case Report *Corresponding Author: S. Gopalakrishnan, Dept. of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India Email: gopalakrishnan_perio@ymail.com http://doi.org/10.18231/j.aprd.2019.019 IP Annals of Prosthodontics and Restorative Dentistry, July-September, 2019;5(3):80-85 80 Available online at www.iponlinejournal.com Journal homepage: www.innovativepublication.com/journal/aprd Immediate implant– An esthetic rescue- Case series S. Gopalakrishnan 1* , Gomathi G.D 2 , G. Kanimozhi 3 , W.R. Gnanasagar 4 1 Professor, 2 Post Graduate, 3 General Dentist (Private Practitioner), 4 Senior Lecturer, 1,2,4 Dept. of Periodontics, 1,2,4 Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India Abstract Extraction followed by placement of immediate implant has become a reliable and time saving method of esthetic and functional rehabilitation of a patient. Achieving good primary stability with preservation of hard and soft tissue is the key to successful placement of immediate implant. With the advent of immediate single-stage implant placement and immediate prosthesis fabrication, the edentulous patients can walk out of the clinic with “Teeth within a day”. Refining clinical protocols, applying sound biomechanical principles, improving implant design, with new implant surfaces have resulted in the increased use of immediate implant. However there are chances of implant failure due to greater crestal bone loss around the healing implants resulting from traumatic extraction. This could be minimized or prevented by atruamatic extraction procedure. Many clinical trials reported survival rates of immediately loaded implants similar to that of two-stage unloaded healing approaches. This article throws a light on atruamatic extraction & various techniques of atruamatic extraction, advantages, disadvantages and success criteria for immediate implant loading. Three cases with different techniques of atruamatic extraction of tooth and immediate implant rehabilitation is reported. Keywords: Atruamatic extraction, Techniques, Immediate implant loading, Advantages and disadvantages of immediate implant loading. Introduction Immediate replacement of missing teeth is what people demand now-a-days. Immediate implants are placed into freshly extracted sockets following extraction. The placement of implants in extraction sockets was first described by Schulte & Heimke. (1976) Schulte et al (1978) referred this procedure as ‘immediate implant’. Loss of single tooth in the esthectic region is the most common indication for immediate implant placement. 1 Extraction followed by immediate implant placement not only improves esthetics but also preserves bone. Placing two- stage implant in the aesthetic zone is a challenging task to the clinician as it is time consuming and involves secondary surgical exposure. Tooth loss not only results in bone resorption but also causes loss of soft-tissue which must be evaluated carefully before treatment planning. Severe bone loss requires ridge augmentation which is a time consuming procedure. Exposure of alveolar bone causes alteration of the biologic width that has to be reestablished. Traumatic extraction of teeth results in damage to the periodontium leading to loss of hard and soft tissues. This will eventually lead to failure of implant. Atraumatic extraction of the teeth plays a key role for successful placement of immediate implants which refers to a process of tooth removal with minimal damage to the periodontal tissues. In contrast, placing immediate implant with a provisional restoration may have some negative consequences. According to patient’s view, the losing tooth in the esthetic region is often traumatic. Esthetics and phonetics is compromised during the traditional two-stage placement. Healing period more demanding both surgically and prosthetically compared to the conventional placement technique. However, waiting period (4-6 months) for osseointegration and the prosthesis fabrication following a two stage surgery were the biggest disadvantage. With the advent of immediate single stage implant placement and immediate prosthesis fabrication, the edentulous patients can receive the replacement in the same appointment. Refining clinical protocols, applying sound biomechanical principles, improving implant design, with new implant surfaces have resulted in the increased use of immediate implant. Immediate loading Immediate loading of implants reduces secondary surgery and aids in providing temporary restoration at the same visit for the patient. Immediate loading on reduced surface area implants increases soft-tissue interface between bone and implant that has better clinical survival. 2 A direct bone- implant interface when developed, had survival for more than 20 years. 3 Tarnow et al 4 reported success of immediately loaded threaded implants with a fixed prosthesis in 10 consecutive cases over 5 years. However uncontrolled systemic conditions like diabetes, patients with oral para-functional habits and heavy smoking are absolute contraindication for immediate implant. A study on 23 periodontally compromised patients suggested that immediate loading implant is a predictable technique with a higher survival rate for provisional and permanent prosthesis 6