Guided tooth autotransplantation of a palatally impacted maxillary canine into the site of a failed maxillary canine implant.

The aim of this report is to demonstrate the guided tooth autotransplantation of a palatally impacted maxillary canine into the site of a failed maxillary canine dental implant. A 47-year-old woman visited a dental clinic complaining of loose dental implant in the left maxillary canine site, tooth #11, as well as pain and swelling of the gum around the implant. The clinical examination revealed a mobile implant along with swollen soft tissues with bleeding on probing. A periapical radiograph demonstrated peri-implant marginal bone loss. Cone beam computed tomography sections revealed that tooth #11 was impacted palatally. The implant was removed and replaced with the impacted canine via guided autotransplantation and posterior orthodontic alignment. The patient was recalled at 1, 3, 6, 9, 12, 24 and 48 months after the procedure. During this period, the patient was symptom-free and radiographic examination at 2 years revealed no periapical pathosis or root resorption.

El reto del abordaje quirúrgico en la rehabilitación sobre un implante unitario en un caso de alto requerimiento estético del sector anterior. Descripción a propósito de un caso / The challenge of the surgical approach in the rehabilitation of a unitary implant in a case of high aesthetic requirements of the anterior sector. Case report

Objetivo: Describir de forma detallada el abordaje clínico basado en la evidencia científica actual de un implante postextracción con carga y provisionalización inmediata. Caso clínico: Se presenta el caso de una paciente mujer de 32 años de edad, que acude por presentar una posible fractura radicular del incisivo central superior izquierdo (ICSI), acompañada de la aparición de un absceso periodontal en la región del fondo de vestíbulo de dicho diente. Tras llevar a cabo la exploración clínica y radiológica, se establece que el pronóstico del ICSI es desfavorable para llevar a cabo un tratamiento conservador del mismo. Tras la valoración de las características clínicas del caso presente, el plan de tratamiento se inclinó por la realización de la exodoncia del ICSI con la colocación simultánea de un IOI postextracción y la carga inmediata con una prótesis provisional del mismo. Conclusiones: La rehabilitación sobre implantes en situaciones de pérdida dental en el sector anterior estético y en especial, en pacientes jóvenes, requiere un plan de tratamiento multidisciplinar en cuanto a la extracción del diente y colocación del IOI en la posición tridimensional correcta, existiendo diferentes aspectos a tener en cuenta para ello, especialmente el remanente óseo residual, la posición del margen gingival, así como la preservación y acondicionamiento de los tejidos duros y blandos periimplantarios mediante injertos y un manejo correcto de una prótesis provisional hasta conseguir un perfil de emergencia y contorno gingival ideal antes de la corona definitiva. (AU)

Objective: To describe in detail the clinical approach based on current scientific evidence for a post-extraction implant with immediate loading and provisionalisation. Clinical case: We present the case of a 32-year-old female patient who presented with a possible root fracture of the upper left central incisor (ULCI), accompanied by the appearance of a periodontal abscess in the region of the bottom of the vestibule of said tooth. After carrying out the clinical and radiological examination, it is established that the ULCI prognosis is unfavourable for carrying out conservative treatment of the tooth. After assessing the clinical characteristics of the present case, the chosen treatment plan was to extract the ULCI with the simultaneous placement of a post-extraction osseointegrated implant (OII) and immediate loading of a provisional prosthesis on the implant. Conclusions: Rehabilitation on implants in situations of tooth loss in the aesthetic anterior sector, especially in young patients, requires a multidisciplinary treatment plan in relation to tooth extraction and placement of the OII in the correct three-dimensional position. There are various aspects to be taken into account, particularly the residual remaining bone, the position of the gingival margin, as well as the preservation and conditioning of the peri-implant hard and soft tissues by means of grafts and proper handling of a provisional prosthesis until an ideal emergence profile and gingival contour is achieved before the final crown. (AU)

Third molar autotransplant planning with a tooth replica. A year of follow-up case report.

The advantages of dental autotransplantation and its high level of clinical success mean that it should be considered as a therapeutic option when replacing a lost tooth. In order to achieve optimum results, it is necessary to know the technique of dental autotransplantation, promoting its use whenever the clinical conditions to perform it are present. The objective of this article is to describe the technique in detail by means of a clinical case of a dental autotransplant whose donor tooth was a third unerupted molar. A 39-year-old male patient with no medical history of interest. On clinical examination, tooth 2.6 shows vertical fracture with indication of exodontia. A compatibility study is carried out using a CBCT and after this, a subsequent preparation of a 3D-printed replica of the donor tooth 2.8 is made. A step-by-step description is given of the autotransplantation technique from 2.8 to 2.6. After this, antibiotic coverage, semi-rigid splinting and root canal treatment are carried out in a short time. Results are shown at 12 months. The main factor for the success of this technique is the preservation of periodontal ligament cells. The unerupted teeth are the only ones that fully preserve the periodontal ligament, but they require greater surgical skills. Autotransplantation is a predictable treatment alternative to dental implants, being above all an option indicated to replace teeth with dental fissures or vertical root fractures or poor restorative and/or endodontic prognosis. The third molars are the most used teeth for transplantation, due to their indications for extraction in a high percentage preserving the entire periodontal ligament. The diagnosis by CBCT and the use of 3D- printed replicas of the tooth to be transplanted have meant a highly significant improvement in the prognosis and predictability of the technique. Key words:Dental autotransplant, tooth replica, third molar.

The challenge of the surgical approach in the rehabilitation of an anterior sector unitary implant in a case of high aesthetic requirements; case report

Objective: Provide a detailed description of the current evidence-based clinical approach to a post-extraction implant with immediate loading and provisionalisation. Clinical case: A 32-year-old female patient who attended for a possible root fracture of the upper left central incisor (ULCI), accompanied by a periodontal abscess at the bottom of the vestibule of the same tooth. A clinical and radiological examination established that the prognosis of the ULCI was unfavourable for conservative treatment. After evaluating the clinical features of the case, the treatment plan to extract the ULCI followed immediately by an osseointegrated implant (OII) and loading of a provisional prosthesis on the implant. Conclusions: Rehabilitation on implants in situations of tooth loss in the aesthetic anterior sector, especially in young patients, requires a multidisciplinary treatment plan to extract the tooth and insert an OII in the correct 3-dimensional position. Various aspects need to be taken into account for this, particularly the residual remaining bone, the position of the gingival margin and preservation and conditioning of the peri-implant hard and soft tissues by means of grafts and proper handling of provisional prosthesis, until an ideal emergence profile and gingival contour is achieved before the final crown. (AU)

Flujo digital en la rehabilitación unitaria sobre implantes en el sector anterior. Planificación quirúrgica y protésica. A propósito de un caso / Digital flow in unitary dental implants rehabilitation in anterior sector. Surgical and prosthetic planning. Case report

OBJETIVO: El objetivo de este artículo es describir la rehabilitación sobre implantes en un caso de alta demanda estética, basando dicho tratamiento en una planificación íntegramente digital. CASO CLÍNICO: Se presenta el caso clínico de una paciente de 52 años de edad que acude por fractura del diente 2.1. Tras el diagnóstico y análisis, tanto de forma clínica como radiográfica, se determina un pronóstico restaurador imposible para el 2.1, planificando como tratamiento una rehabilitación implantosoportada. Se realizó un escaneado de la zona a tratar para llevar a cabo un estudio detallado del caso y la confección de una corona provisional, la cual se atornilló en el mismo momento de la cirugía a un implante colocado de forma inmediata postextracción. Sumado a ello, se realizaron injertos de tejido duro y blando para asegurar el mantenimiento de los contornos periimplantarios. Tras el periodo de integración del implan-te, se trabajó el contorno de la corona provisional hasta conseguir un perfil de emergencia y un volumen de tejido gingival idóneos. Tanto el perfil de emergencia conseguido como el contorno del provisional fueron escaneados, junto con la posición del implante, para la confección de la restauración metal-cerámica definitiva. A los 6 meses tras la finalización del caso, se observa una estética de tejidos blandos idónea y un mantenimiento perfecto de toda la arquitectura gingival. CONCLUSIÓN: El manejo del sector estético anterosuperior evidencia una clara exigencia estética. En casos de pérdida dentaria en esta localización, la rehabilitación fija sobre implantes es el tratamiento de elección. No obstante, para conseguir un resultado adecuado y predecible, es esencial un correcto manejo quirúrgico y protésico. La planificación mediante medios digitales supone un salto de calidad en el enfoque terapéutico de estos casos, permitiendo un tratamiento más exacto e individualizado y siendo, además, más sencilla y eficiente la información que se traslada al laboratorio protésico

AIM: The purpose of this article is to present a clinical case of high aesthetic demand. Such planning and treat with digital flow, included diagnosis, prosthetic planning and finally, the placement of the final prosthesis. CASE REPORT: A 52-year-old woman presents a fracture of the tooth 2.1. After diagnosis and analysis both clinically and radiographically, an impossible restorative prognosis is determined for 2.1, planning implant-supported rehabilitation as treatment. A scan of the area to be treated was carried out to carry out a detailed study of the case and the preparation of a provisional crown, which was screwed at the same time of surgery to an implant placed immediately post-extraction. Besides, hard and soft tissue graft were placed to guarantee the maintenance of the peri-implant contours. After the implant osteointegration, the contour of the provisional crown was scanned to obtain a suitable emergence profile and gingival tissue volume. Both the emergency profile obtained and the contour of the provisional were scanned together with the position of the implant for the preparation of the final metal-ceramic restoration. After six months, it can observe an ideal soft tissue aesthetic and perfect maintenance of the entire gingival architecture. CONCLUSION: The management of the anterior superior aesthetic sector shows a clear aesthetic demand. In cases of tooth loss at this location, fixed implant rehabilitation is the treatment of choice. However, to achieve an adequate and predictable result, proper surgical and prosthetic management is essential. Digital flow it present like alternative and a quality leap in the therapeutic approach to these cases, a more accurate and individualized treatment, and the information that is transferred to the prosthetic laboratory is more simple and efficient