Twenty eight months marginal bone level follow-up of an immediate post-extractive implant with immediate definitive loading

Objective. The aim of this case report was to show the marginal bone level (MBL) variation, after 28 months, around an aesthetic post-extraction implant immediate loading positioned in a 46-years-old woman. Material and methods. After a careful evaluation of the X-rays and CBCT images, a 4×13 conical implant was placed in seat 21 after the atraumatic extraction of the fractured element and the management of the infected area. Correct primary stability (torque 70 Ncm) was obtained by inserting the implant in a palatal position with respect to the alveolus. To complete the surgery, regeneration procedures were carried out using a granular bone substitute (Geistlich Bio-Oss®) covered with a connective tissue graft taken from the palate. Just three days later, a straight titanium abutment Curvomax™ with gold tite (UNIHG) was screwed (35 Ncm) and a lithium disilicate glass ceramic crown was cemented. Results. The radiographic analysis of the MBL at 28 months of follow-up shows a significant stability of the peri-implant bone confirmed by an excellent aesthetic integration of the soft tissues around the prosthetic crown. Conclusions. A careful and dedicated surgical planning accompanied by the use of appropriate materials and an accurate surgical protocol, seems to allow the rehabilitation of frontal areas that is difficult to manage, obtaining excellent aesthetic, functional and predictable results over time. We believe that the goal, in this case, is also linked to the immediate delivery of the final crown which has significantly reduced operating times and improved aesthetic parameters, translating into better patient satisfaction.