Treatment Plan for Implant-Supported Crown Replacement of Fractured Maxillary Premolar (Tooth 15) with Image-Guided Implantology

Certainly! Below is a detailed treatment plan for the replacement of a fractured, nonrestorable maxillary premolar (tooth 15) using image-guided implantology, focusing on minimal invasive implant surgery and leveraging AI-based prediction for osteointegration success.

Initial Assessment

1. Clinical Evaluation:
   • Comprehensive oral examination to assess overall oral health.
   • Assessment of the fractured tooth 15 and surrounding tissue condition.
2. Radiographic Analysis:
   • Obtain CBCT (Cone Beam Computed Tomography) scans for precise evaluation of bone quality, quantity, and anatomical landmarks.
   • Use digital radiography for initial assessment and planning.
3. AI Analysis:
   • Utilize AI software to analyze CBCT data for insertion torque prediction and osteointegration success. This involves examining bone density and anatomical structures critical for implant placement.
   • Classify the case based on SAC (Straightforward, Advanced, Complex) augmented with AI insights to determine the complexity of the procedure.

Treatment Plan

Pre-Surgical Phase

1. Digital Planning:
   • Use image-guided software to create a digital model of the patient’s jaw and plan the exact position, angle, and depth of the implant.
   • Simulate the surgical procedure virtually to plan for optimal implant placement with minimal invasion.
2. Surgical Guide Fabrication:
   • Fabricate a custom surgical guide based on digital planning that will assist in precise implant placement.

Surgical Phase

1. Minimal Invasive Implant Placement:
   • Utilize flapless surgical techniques to avoid large incisions, leading to reduced trauma and faster recovery.
   • Guided by the custom surgical guide, place the implant in the predetermined position ensuring accuracy as per the digital plan.
2. Real-Time AI Assistance:
   • Use AI-powered tools to provide real-time feedback during the implant procedure, ensuring optimal insertion torque which is crucial for immediate stability and long-term success.

Post-Surgical Phase

1. Immediate Post-Operative Care:
   • Prescribe appropriate pain management and antibiotics if necessary.
   • Advise on post-surgical care including diet modifications and oral hygiene.
2. Healing and Osteointegration Monitoring:
   • Schedule follow-up appointments to monitor healing progress and integration of the implant.
   • Utilize AI to predict and track osteointegration success during the healing period based on patient-specific data.
3. Prosthetic Phase:
   • After successful integration, proceed with the placement of the abutment and fabrication of the implant-supported crown.
   • Ensure that the crown is designed for optimal aesthetic and functional results in harmony with the patient’s occlusion.

Advantages of This Approach

• Precision and Accuracy: Image-guided implantology ensures precise placement reducing the risk of complications.
• Reduced Trauma and Faster Recovery: Minimal invasive techniques and flapless surgery contribute to less discomfort and quicker healing.
• AI-Based Prediction: Enhances decision-making by providing predictive insights into implant success, which aids in planning and execution.
• Customized Treatment: The use of digital planning and surgical guides leads to a tailored approach that caters specifically to the patient’s anatomy.

This treatment plan not only enhances the success rate of the implant procedure but also improves the overall patient experience by reducing operative time, discomfort, and post-operative complications.

Treatment Plan for Replacement of Fractured Maxillary Premolar (Tooth #15) with Implant-Supported Crown

Introduction

In the realm of modern dentistry, image-guided implantology has revolutionized the approach to implant placement, offering precision, reduced invasiveness, and increased predictability. The Medlibre AI-SAC classification system provides a framework for assessing the complexity of dental implant cases, guiding clinicians in developing tailored treatment plans that address both aesthetic and functional concerns. In this case, we will employ this system to devise a strategic approach for the replacement of a fractured, nonrestorable maxillary premolar with an implant-supported crown.

Patient Analysis

Patient Information:
– Name: Peter OSSTELL
– Age: 58 years
– Gender: Male

Chief Complaint:
– The patient presents with a fractured and nonrestorable maxillary left second premolar (tooth #15) seeking replacement with an implant-supported crown.

Medical History:
– Hypertension: Managed with Ramipril 2.5 mg daily.
– Hyperlipidemia: Managed with Simvastatin 20 mg daily.
– Aspirin: 81 mg daily.
– Social History: Nonsmoker, occasional alcohol consumption.

Clinical Findings:
– Tooth #15: Extensive caries, nonrestorable, indicated for extraction.
– Tooth #16: Failed restoration, requires a full-coverage restoration after implant surgery.
– Periodontal Status: Healthy.
– Bone Condition: Adequate volume and dimensions for implant placement as confirmed by CBCT.
– Aesthetic Considerations: Tooth #15 is not visible during a full smile.
– Gingival Biotype: Thick with adequate keratinized tissue.

Medlibre AI-SAC Classification

Based on the factors evaluated, this case is classified as Straightforward (S):
– Aesthetic Risk: Low, as tooth #15 is not visible in the aesthetic zone during a full smile.
– Bone Availability: Adequate bone volume in all dimensions with no need for bone augmentation.
– Soft Tissue Condition: Healthy gingiva with sufficient keratinized tissue and no need for grafting.
– Risk of Complications: Low risk, given the patient’s overall health status and the non-complexity of the site.
– Surgical Complexity: Simple implant placement with no significant anatomical challenges.

Treatment Plan

Phase 1: Pre-Surgical Planning

1. Radiographic and Clinical Assessment:
   • Analyze CBCT images to assess bone volume and proximity to the maxillary sinus.
   • Evaluate adjacent teeth to ensure optimal implant positioning without interference.
2. Surgical Guide Fabrication:
   • Collaborate with a restorative dentist to fabricate a custom surgical guide based on digital impressions and CBCT data to ensure precise implant placement.
3. Informed Consent:
   • Discuss the procedure, risks, benefits, and alternatives with the patient.
   • Obtain signed consent after ensuring patient understanding.

Phase 2: Tooth Extraction and Site Preparation

1. Atraumatic Extraction of Tooth #15:
   • Carefully extract the nonrestorable tooth to preserve the alveolar bone and surrounding tissue integrity.
   • Curettage to remove any residual infection or granulation tissue.
2. Socket Preservation:
   • Evaluate the extraction site for any residual defects.
   • Ensure adequate blood clot formation to support natural healing.

Phase 3: Implant Placement

1. Image-Guided Surgery:
   • Utilize the surgical guide to place a titanium implant at the site of tooth #15.
   • Achieve primary stability with adequate torque levels for successful osseointegration.
2. Immediate Temporary Restoration:
   • If feasible, place a temporary crown to maintain aesthetics and soft tissue architecture.

Phase 4: Healing and Osseointegration

1. Healing Period:
   • Allow 3-4 months for osseointegration under non-loading conditions.
   • Monitor the site for signs of infection or peri-implantitis.

Phase 5: Prosthetic Restoration

1. Implant-Supported Crown Fabrication:
   • After successful osseointegration, take final impressions for the fabrication of an implant-supported crown.
   • Collaborate with the lab to ensure optimal occlusion and aesthetics.
2. Crown Placement:
   • Secure the implant crown with consideration for occlusal forces during function.
   • Ensure the restoration integrates seamlessly with the patient’s existing dentition.

Phase 6: Restoration of Adjacent Tooth #16

1. Treatment of Tooth #16:
   • Proceed with full-coverage crown restoration for tooth #16, ensuring proper alignment and function post-implant placement.

Phase 7: Follow-Up and Maintenance

1. Regular Check-Ups:
   • Schedule periodic reviews to assess implant health, crown integrity, and overall oral hygiene.
   • Reinforce the importance of regular dental visits and proper hygiene practices.

Conclusion

The replacement of a fractured maxillary premolar with an implant-supported crown in this case is classified as Straightforward based on the Medlibre AI-SAC system. The treatment plan developed ensures a predictable outcome with minimal risk, leveraging image-guided technologies for precision and patient safety. The patient can expect a restoration that is both functional and aesthetically pleasing, supported by regular follow-up care to maintain oral health.

Sign-off:
TMJ (AI generated)
Date: 19 09 2024

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

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