For immediate implant placement we need an implant design that helps us achieve good primary stability for subsequent immediate restoration or loading. According to recent clinical reports and trials, the new Straumann^® BLX implant offers the perfect properties for these clinical situations. At the same time, the SLActive^® surface plays a crucial role at the early stage of osseointegration of immediate implant placement, just as the Roxolid^® does in the implant material. Since Straumann^® BLX prosthetic components have different gingival heights, they are very suitable for immediate implant placement and restoration.

Initial situation

A 28-year-old female visited our clinic with a fractured central left upper incisor (Figs. 1,2). The patient was in good health, a non-smoker, with good oral hygiene. She had a medium lip line and a rectangular tooth shape (Fig. 3). A buccal plate was not identified on the cone beam computed tomography (CBCT) scan, which showed root perforation with excess material but no periapical lesion (Fig. 4). The tooth had to be extracted according to the clinical and radiological assessment. As the fractured tooth was in the esthetic zone, the patient needed the restoration as soon as possible.

Treatment planning

Given the clinical and radiological situation, immediate implant placement and restoration was chosen as the treatment modality. As the buccal plate was absent, the plan was to extract the tooth atraumatically, remove excess material and regenerate the defect for subsequent placement of the Straumann^® BLX Roxolid^®, SLActive^® 3.75 x10 mm with immediate temporary restoration (Fig. 5).

Surgical procedure

Under local anesthesia, the coronal part and the root of the fractured tooth were removed, together with the excess material (Figs. 6-8). The implant bed was prepared building up to a 2.8 mm drill (Fig. 9). After evaluation of the buccal bone defect, a cortical/cancellous bone block and connective tissue graft were harvested from the tuberosity (Figs. 10,11). The bone block was adapted and fixed in the vestibular part of the extraction socket (Fig. 12). The connective tissue graft was prepared and sutured subgingivally (Fig. 13). The Straumann^® BLX implant was placed with a torque of 50 Ncm (Fig. 14).

Prosthetic procedure

The temporary abutment was shortened and screwed to the implant, the wound was isolated (Figs. 15,16). The vestibular part of the crown of the extracted tooth was used as a veneer for the temporary crown (Fig. 17). It was connected to the abutment using the silicone key. Next, the temporary restoration was finished extraorally in the analog holder (Fig. 18). It was tightened to the implant with 15 Ncm. A periapical x-ray confirmed the implant and restoration (Fig. 19). The screw hole was closed with Teflon tape and composite (Figs. 20,21).

Treatment outcomes

The patient was very pleased to obtain immediate restoration right after tooth extraction and implant placement. At the 3-month follow-up we observed stable peri-implant tissues and gingival contouring (Figs. 22,23). The Straumann^® BLX implant is a perfect solution for immediate implant placement due to its anatomical design, TorcFit™ connection, surface and material.