When patients present for treatment with a broken tooth in the esthetic zone, they are typically in an urgent, even panicked, state of mind. In addition to the pain and compromised dental function, there is the fear that they will have to be around other people without the ability to talk and smile with their usual confidence. The extraction with immediate implant placement procedure is an invaluable service for such patients, as it quickly addresses their dental emergency in a single appointment. Since I have learned to perform this procedure, I have been able to extract the broken tooth, place an implant and deliver an immediate provisional restoration for nearly every patient who visits my office with a fractured tooth in the anterior.

In addition to addressing the urgent need of the patient, this procedure establishes an incredible reputation for your practice. Many patients are shocked that their broken tooth can be replaced on the very day they sought treatment, and are quick to tell their friends and family about their experience. And the final outcome is just as predictable as the results achieved through delayed implant placement, so you’re also providing a restoration that the patient can count on over the long term.^1,2

Here, I will outline this life-changing and practice-building procedure, including diagnosis, tooth extraction, immediate implant placement, and immediate provisionalization. To illustrate each step, I’ll include a case report that shows how simple this procedure can be and the exceptional results it produces when the proper techniques, protocol and principles are observed. Implant and material selection are also important considerations, so I’ll discuss the implant system and biologics that have worked best for me in my practice.

The patients who are best served by the extraction with immediate implant placement procedure — or, as some call it, “the emergency implant” — have commonly experienced some kind of accident that has damaged a tooth in the esthetic zone. In this particular case, the patient suffered an injury that caused her existing crown on tooth #8 to completely fracture off at the gumline. The tooth and her other central incisor, both of which had received root-canal treatment in the past, suffered from severe recurrent caries necessitating tooth replacement. The patient did not want to depend on a removable appliance or have her healthy lateral incisors reduced to support a 4-unit bridge, so I evaluated her bone levels intraorally and radiographically for immediate implant placement.

The patient had sufficient vertical and horizontal bone levels for implant placement, and the buccal plate was intact. Her healthy bone and soft tissue, as well as her urgent situation in the anterior, made her an excellent candidate for extraction with immediate implant placement, and she happily agreed to move forward with the procedure. After anesthetizing the patient, I atraumatically removed the central incisors. The practitioner’s extraction method of choice may be used as long as great care is taken to preserve the buccal plate, which is essential to the emergency implant procedure. In this case, the buccal plate was not damaged during the extractions, so I proceeded with immediate implant placement. Note that an immediate implant should not be placed in cases where the buccal plate is damaged. Instead, a “graft and wait” protocol should be followed.

For the implant placement procedure, two 3.5 mm x 13 mm Hahn^™ Tapered Implants were selected. The Hahn Tapered Implant is my implant system of choice, and the deep, sharp threads of the implant are ideal for the emergency implant procedure as they keep the implant engaged with the palatal wall during placement and excel in establishing the high primary stability needed for a predictable outcome.

The implant osteotomies were completed, and the Hahn Tapered Implants were placed into the prepared extraction sites. The implants were positioned a safe distance from the buccal plate and achieved excellent initial stability. Next, I filled the gaps between the implants and the extraction sockets with Newport Biologics^™ Mineralized Cortico/Cancellous Allograft Blend . This blend of cortical and cancellous grafting material is optimal for immediate implant cases due to its ability to enable complete, predictable bone regeneration and formation at the extraction site.

The patient left the surgical appointment in very good spirits after initially presenting for treatment in a distraught state. After four months, she returned so I could assess the healing of the implant sites and the integration of the Hahn Tapered Implants. Excellent soft tissue health and contours were evident around the provisional crowns, and radiography revealed excellent bone levels around the Hahn Tapered Implants.

Hahn Tapered Implant impression copings were seated, and final impressions were taken using vinyl polysiloxane (VPS) impression material. The case was sent to Glidewell for restoration, including a prescription for all-ceramic crowns over custom abutments and photographs of the patient’s provisional restorations in place.

Upon receipt of the final impressions, Glidewell digitized the case by pouring and scanning the master model. A lab technician designed the final restorations using advanced CAD software. The titanium custom abutments were fabricated from titanium alloy and anodized to achieve a gold tone, facilitating lifelike esthetics and eliminating any concerns with gray show-through in the esthetic zone. All-ceramic implant crowns were produced, featuring esthetics that aligned closely with those of the provisional crowns, with which the patient was pleased. The case was returned to the practice for final delivery of the implant restorations.

At the final delivery appointment, the gold-tone custom abutments were seated and established precise, slightly subgingival margins for the implant crowns.

The implant crowns were tried in and then cemented over the custom abutments. Because the position of the gingiva was maintained throughout treatment with the immediate provisional crowns, as well as the custom fit and margins of the custom abutments, the final restorations exhibited lifelike emergence profiles. The patient was extremely happy with the final outcome, which improved her smile in addition to restoring function. She was especially pleased that she was able to have fixed teeth throughout treatment and remarked that she frequently shares her experience with her friends and family.

Extraction with immediate implant placement can be a predictable, straightforward procedure that transforms a dental emergency into a rewarding experience for the clinician and patient alike. By giving someone back their tooth in a single appointment — and with it their confidence and dignity — we are able to provide for the immediate and long-term needs of the patient. I have found that this type of treatment contributes to excellent long-term relationships with my patients and has generated numerous referrals for my practice.