Dental Dam Isolation for Crown Removal, Atraumatic Tooth Extraction, Immediate Implant Placement, and Restoration Cementation: A Case Study

G Guzman-Perez; S Rojas-Rueda; F Floriani; A Unnadkat; C-C Fu; CA Jurado

doi:10.2341/24-040-S

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Article Contents

SUMMARY
INTRODUCTION
METHODS AND MATERIALS
DISCUSSION
CONCLUSION
REFERENCE

Editorial Type:

Article Category: Case Report

Online Publication Date: 06 Jan 2025

Dental Dam Isolation for Crown Removal, Atraumatic Tooth Extraction, Immediate Implant Placement, and Restoration Cementation: A Case Study

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Page Range: 5 – 11

DOI: 10.2341/24-040-S

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SUMMARY

Objectives:

This case report describes the clinical protocols for the removal of crowns, tooth extraction, immediate implant placement, and cementation of new crowns, all performed under total or partial isolation with a dental dam.

Clinical Considerations:

The patient’s chief complaint was dissatisfaction with her smile. Radiographic and clinical evaluations led to the recommendation to replace the porcelain-fused-to-metal crowns on the maxillary central and lateral incisors with all-ceramic crowns. Considering the patient’s wide smile, ceramic veneer restorations were also recommended for the maxillary canines and first premolars. An immediate implant placement was advised to replace the fractured maxillary right central incisor.

Conclusions:

Well-planned dental care including crown removal, tooth extraction, immediate implant placement, and cementation of new restorations can be successfully executed under isolation using a dental dam. The isolation improves access, visibility, and hygiene by preventing cross-contamination during the cementation procedure. The final outcome fulfilled the patient’s esthetic demands.

Figure 1

Initial presentation. (A) Extra-oral facial smile, (B) intra-oral frontal view smile, (C) close-up of crown with open margin, and (D) periapical radiograph showing open margin.

Figure 2

Diagnostic wax-up. (A) Diagnostic impression, (B) cast, and (C) diagnostic wax-up.

Figure 3

Removing old crowns and tooth extraction. (A) placement of dental dam, (B) sectioning old PFM crowns with diamond burs, (C) occlusal view of crowns removal, (D) removing central incisor, (E) tooth extracted (occlusal view), and (F) radiograph of extraction site.

Figure 4

Immediate implant placement. (A) First drill of immediate implant placement, (B) implant drill with depth and precise angulation according to interproximal contact and incisal angulation of interproximal teeth, (C) radiograph showing interproximal root distance (D) implant placement, and (D) occlusal view of the socket after implant placement.

Figure 5

Grafting and provisional restoration. (A) evaluating the size of the graft tissue, (B) provisional implant post, (C) provisional restorations, (D) placement of the provisional restoration and final suturing, and (E) radiograph of the provisional restoration.

Figure 6

Healing and final impression. (A) Follow-up of two weeks after surgery, (B) four months of healing with single crowns provisional, (C) teeth and implant ready for impression, and (D) final impression.

Figure 7

Fabrication of the final restorations. (A) Master cast, (B) lithium disilicate ingots, (C) restorations with cut-back, (D) final restorations in master cast, and (E) implant abutment and crown.

Figure 8

Cementation process under dental dam isolation. (A) Frontal view, (B) left canine veneer cementation, (C) all restorations cemented frontal view, and (D) dental dam removal.