Surgical Removal and Immediate Implant Placement with Buccal Bone Grafting and Composite Resin Bridge at #31

Implant Placement

Chief Complaint

Patient presented after accidentally biting into a fork while eating, resulting in avulsion of tooth #31. Patient reported excessive bleeding due to anticoagulant medication (warfarin).

Clinical Findings

Avulsed mandibular left central incisor (#31).
Patient on warfarin therapy with increased bleeding tendency.

Pre-operative CBCT taken and implant site position planned.

Treatment Plan

Immediate implant placement at site #31.
Buccal bone grafting to support implant.
Immediate temporization with a composite resin bonded bridge using adjacent teeth (#32 and #41).
Root planing of #32 and #41.
Patient counseled on risks, benefits, alternatives, and potential complications.

Informed consent obtained.

Pre-operative Assessment

CBCT reviewed to plan implant position.
Medical history noted (anticoagulant therapy).

Patient stable for local anesthesia.

Anesthesia

Left inferior dental nerve block, lingual nerve block, and long buccal nerve block administered.

Surgical Procedure

Patient prepared and draped.
Incision made and buccal flap raised.
Implant site prepared with sequential drills and osteotomes.
Implant preconditioned with Megagen plasma blasting.
A 3.0 mm × 11.5 mm Megagen AnyOne Mini Implant placed at site #31.
Healing abutment (3.5 mm diameter × 7.0 mm height) placed.
Thin buccal bone noted with implant showing through.
Flap released and augmented with buccal bone grafting using 6.0 mm × 10.0 mm Dentium Osteon Collagen II graft material.
Six interrupted sutures placed using 6/0 Surgipro Polypropylene for primary closure.
Hemostasis achieved and post-operative instructions given.