Immediate Implantation and Immediate Definitive Lithium Disilicate Custom Abutment: A Case Report

Aim: Proper implant position, reduced number of visits in the dental office, reduced overall treatment time and costs, preservation of bone at the site of implantation, optimal soft tissue esthetics, and enhanced patient satisfaction are the major advantages of immediate implant placement. Repeated abutment manipulation leads to the tear of the mucosal seal around the healing caps and/or abutments and as a consequence, biologic width may migrate apically and marginal vertical bone loss may occur. Fabrication and insertion of definitive customized abutment immediately after implantation may prevent this migration. Case: The upper left first premolar with the vertical tooth fracture was extracted and immediately a bone level implant was inserted (Conelog; diameter: 4.3 mm and height: 11 mm) in the 50-year-old female patient. Immediatly after implantation, a digital impression (Cerec Bluecam AC, Sirona) was made using a titanium base and a scan-body. A premolar crown and a custom abutment were designed (Cerec 4.0, Sirona) and the abutment was milled (Cerec MCXL, Sirona) from a lithium-disilicate abutment block (e.max Abutment Solutions, A14, MO, IvoclarVivadent). Following crystallization procedures, the collar of the ceramic part was mechanically polished and luted to the titanium base using a self-curing resin cement (Multilink Hybrid Abutment, IvoclarVivadent). The hybrid abutment was tried intra-orally to check the appropriate emergence profile and the coronal part was modelled from a composite resin with layering technique leaving the screw hole exposed. Following the polishing procedures, the abutment crown was placed and torqued with 15 Ncm. After 3-months, only the temporary coronal part was removed and the final restoration was produced on the previous digital data from a glass ceramic block (e.max CAD, IvoclarVivadent) by a CAD/CAM system (Cerec MCXL). The final crown was luted using a dual-curing resin cement (RelyX ultimate, 3M ESPE) and the patient was followed up for 9 months. Conclusion: The results of this case report suggest that especially soft tissue structure and bone loss can be prevented by not dis/reconnecting the mounted individualized abutment immediately following immediate implant placement. Keywords: Immediate implantation, custom abutment, lithium disilicate