Cone-beam computed tomography evaluation of the possibility of fabrication of screw-retained implant crowns on maxillary central incisors

Abstract

BACKGROUND: Immediate implant placement to the fresh socket of the extracted tooth, with immediate loading, is well documented. Dental roots in proximity to the vestibular plate require thorough attention from clinicians. Implants placed close to the vestibular plate often lead to its resorption and gingival recession. Therefore, dental surgeons place implants 23 mm away from the vestibular plate. In turn, prosthodontists plan implant placement so that the screw channel is not on the vestibular surface, which is most significant in the aesthetic area. However, this is not always possible, and there is a conflict between implant placement with proper primary stability and its simultaneous loading with a screw-retained crown. AIM: To conduct radiological assessment of the ideal implant placement for a screw-retained crown. MATERIALS AND METHODS: A total of 120 cone-beam computed tomography (CBCT; 3 groups of 40 people with different root positions) were analyzed. In each group, the possibility of extracting tooth 1.1 and inserting an implant was evaluated in compliance with the protocol for immediate implantation and the possibility to have the screw shaft of the artificial crown on the palatal surface. RESULTS: Group C was defined as the most favorable for immediate implant placement with a screw-retained crown. The least favorable was group N. In total, the screw channel in 40% of the cases was located palatally, 26.6% to the incisal edge, and 33.3% on the vestibular surface. CONCLUSIONS: Careful analysis of CBCT when planning implant-supported restoration in the aesthetic area is an integral part of the treatment. A team approach is required from surgeons and prosthodontists when planning. In a larger percentage of cases, implant-supported prosthetics in the maxillary central incisors involve the use of alternative solutions for the restoration of screw-retained crowns.