Dental Implant Treatment Planning in the Post-Traumatic Rehabilitation of the Anterior Maxilla: A Report of Three Cases

Abstract

Evidence-based algorithms guiding treatment of traumatic dentoalveolar injuries prescribe specific interventions in the presence of various sets of historical and clinical cues. However, the staging of dental implant placement in post-traumatic rehabilitation—indeed, whether to consider implant therapy at all—remains more art than science, prior authors cautioning that universal rules do not apply. The purpose of this report is to present treatment approaches applied in three traumatic episodes involving the anterior maxilla. Three patients presented to the Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Fort Eisenhower, GA, USA, following traumatic injuries to the anterior maxilla with varying degrees of severity. In two cases, central incisors were replaced using immediate implants and immediate provisionalization (IIPP). At one IIPP site, extraction was delayed for eight weeks to permit healing of an alveolar fracture. In the third case, the patient received a non-implant rehabilitation due to severe alveolar destruction. Both patients receiving IIPP expressed satisfaction with immediate esthetics, and in both cases, the provisional restoration prevented extraction-related soft tissue collapse. Trauma adds an element of uncertainty to the technically demanding task of implant placement in the esthetic zone. When appropriate, IIPP in the post-traumatic rehabilitation of the anterior maxilla may mitigate some of the known biopsychosocial consequences of oral trauma and facilitate development of favorable mucosal and osseous architecture at the site. Individualized treatment planning is critically important due to wide variability in site characteristics and injury complexity.