Case Report doi:10.2209/tdcpublication.2019-0004 Extraction of Maxillary Impacted Teeth with Simultaneous Immediate Full Mouth Loading Using Long Implant: A Case Report Yoshiaki Shimoo1), Takashi Uesugi1), Masaru Hiruta1), Yuichi Ishiura1), Kazuhisa Nakayama1), Tae Watanabe1), Kazuho Yamada1), Hidetomo Hirouchi2), Masahito Yamamoto2), Satoru Matsunaga2) and Shinichi Abe2) 1) Malo Clinic, Tokyo, 7-8-10 Ginza, Chuo-ku, Tokyo 104-0061, Japan 2) Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misakicho, Chiyoda-ku, Tokyo 101-0061, Japan Received 14 January, 2019/Accepted for Publication 9 May, 2019 Published Online in J-STAGE 5 June, 2020 Abstract Here, we describe the provision of an implant-supported prosthesis in a patient with impacted teeth in the maxilla, which complicated implant placement and necessitated utilization of the extraction sockets of previously impacted teeth and residual submerged roots. The patient was a 63-year-old man who visited our clinic with the chief complaint of difficulty in mastication. Numerous residual roots were observed in the maxilla, and radiographic imaging revealed that the residual roots of teeth #13 and #16 were fully impacted. The patient complained of a strong sensation of a foreign body in the area of a denture support overlying these residual roots. Therefore, the impacted teeth were extracted, 5 implants placed, and a temporary prosthesis provided. Given the necessity of placing the implant through the extraction socket of the impacted canine (#13), favor- able initial stability was achieved using a long (>20 mm) implant. Moreover, autogenous bone obtained by osteotomy was grafted onto the extracted impacted tooth socket. The clinical condition was stable at approximately 1 year after implant placement and so the final prosthesis was delivered, with periodic check-ups being performed every 3 months thereafter. After 4 years, the patient has reported no symptoms. Clinically, there are no signs of inflammation, and the postoperative condition is deemed to be very favorable. Key words: Impacted tooth — Implant — Immediate loading — Long implant Introduction rary prosthesis attachment following extrac- tion has drawn attention recently as a means Immediate implant placement and tempo- of shortening the treatment period and 【版面】W：396 pt（片段 192 pt） H：588 pt 【本文】行数不明（手組み） 10pt 12pt 送り 【図】●図番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std 図タイトルと説明のアキ 9Q ●タイトル折り返し：番号の後（続 く説明の先頭は字下げ不要） ●図説の幅 片段：片段固定 全段：図幅 【表】●番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std タイトルと表のアキ 10.5Q ●罫線 表はじめのみ双罫 表中の 罫の太さ 1.411mm ●表中：11.3Q 12.7H New Baskerville ITC Std ●脚注 11.3Q 12.7H New Baskerville ITC Std 字下げなし 斜体は New Baskerville ITC Std Italic（タグは <l>） 半角ダーシはShimoo -（ハイフン）に Y et al. F50：tohaba の文字スタイルをかけて作成 a b Fig. 1 Intraoral photographs at initial visit 【版面】W：396 pt（片段 192 pt） H：588 pt 【本文】行数不明（手組み） 10pt 12pt【版面】W：396 pt（片段 192 送り pt） H：588 pt 【本文】行数不明（手組み） 10pt 12pt 送り 【図】●図番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC 【図】●図番号・タイトル・説明：11.3Q 12.7H NewStd 図タイトルと説明のアキ 9Q ●タイトル折り返し：番号の後（続a. Frontal intraoral view, b. Occlusal intraoral Baskerville view ITC Std 図タイトルと説明のアキ 9Q ●タイトル折り返し：番号の後（続 く説明の先頭は字下げ不要） ●図説の幅 片段：片段固定 全段：図幅 く説明の先頭は字下げ不要） ●図説の幅 片段：片段固定 全段：図幅 【表】●番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std タイトルと表のアキ 10.5Q ●罫線 表はじめのみ双罫 表中の【表】●番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std タイトルと表のアキ 10.5Q ●罫線 表はじめのみ双罫 表中の 罫の太さ 1.411mm ●表中：11.3Q 12.7H New Baskerville ITC Std ●脚注 11.3Q 12.7H New罫の太さ 1.411mm ●表中：11.3Q 12.7H New Baskerville ITC Std Baskerville 字下げなし ITC Std ●脚注 11.3Q 12.7H New Baskerville ITC Std 字下げなし 斜体は New Baskerville ITC Std Italic（タグは <l>） 半角ダーシは -（ハイフン）に斜体は New F50：tohaba Baskerville の文字スタイルをかけて作成ITC Std Italic（タグは <l>） 半角ダーシは -（ハイフン）に F50：tohaba の文字スタイルをかけて作成 Fig. 3 Panoramic radiograph image at patient’s initial visit Fig. 2 Maximal smile photograph rary prosthesis. This method yielded favor- achieving early functional recovery8). Placing able results. an implant in an edentulous region with impacted teeth requires care: effort must be made to avoid contact between the implant Case Presentation body and the impacted tooth; or the impacted tooth must be extracted to allow the bone to The patient was a 63-year-old man who vis- heal before placement is carried out. The size ited our clinic in July 2013 with the chief com- and morphology of impacted tooth sockets plaint of difficulty in mastication related to are irregular, so achieving initial fixation pain under his denture in the region of when placing an implant in an extraction retained roots. His medical history revealed socket can be technically challenging. More- nothing of note. over, few reports have investigated simultane- The present case report was approved by ous impacted tooth extraction and implant the Institutional Review Board/Ethics Com- placement3,9,11,14,17) with immediate loading5). mittee of the Universal Implant Research Here, we describe a case of complete maxil- Institute (2018-1). Written informed consent lary prosthesis placement in a patient with was obtained from the patient for inclusion in impacted teeth. Extraction of an impacted this study. canine tooth and occlusal reconstruction were performed simultaneously using a long 1. History of present illness implant penetrating the extraction socket, During his late 40 s, the patient had received followed by immediate delivery of a tempo- maxillary and mandibular removable partial 【版面】W：396 pt（片段 192 pt） H：588 pt 【本文】行数不明（手組み） 10pt 12pt【版面】W：396 pt（片段 192 送り pt） H：588 pt 【本文】行数不明（手組み） 10pt 12pt 送り 【図】●図番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC 【図】●図番号・タイトル・説明：11.3Q 12.7H NewStd 図タイトルと説明のアキ 9Q ●タイトル折り返し：番号の後（続 Baskerville ITC Std 図タイトルと説明のアキ 9Q ●タイトル折り返し：番号の後（続 く説明の先頭は字下げ不要） ●図説の幅 片段：片段固定 全段：図幅 く説明の先頭は字下げ不要） ●図説の幅 片段：片段固定 全段：図幅 【表】●番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std タイトルと表のアキ 10.5Q ●罫線 表はじめのみ双罫 表中の【表】●番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std タイトルと表のアキ 10.5Q ●罫線 表はじめのみ双罫 表中の 罫の太さ 1.411mm ●表中：11.3Q 12.7H New Baskerville ITC Std ●脚注 11.3Q 12.7H New罫の太さ 1.411mm ●表中：11.3Q 12.7H New Baskerville ITC Std Baskerville 字下げなし ITC Std ●脚注 11.3Q 12.7H New Baskerville ITC Std 字下げなし 斜体は New Baskerville ITC Std Italic（タグは <l>） 半角ダーシは -（ハイフン）に斜体は NewTooth F50：tohaba Baskerville Extraction の文字スタイルをかけて作成ITC Stdand Italic（タグは Implant Placement <l>） 半角ダーシは -（ハイフン）に F50：tohaba の文字スタイルをかけて作成 Fig. 4 Three-dimensional computed tomography image of impacted teeth Fig. 5 Implant placement simulation using 3-dimen- sional computed tomography images dentures to replace missing teeth. These den- tures were hardly ever used, however, as they induced a strong sensation of a foreign body 3. Imaging findings in the denture-bearing area. Panoramic radiographs revealed that #13 The patient was referred to our clinic in was impacted, and a tooth-like radiopaque June 2013 due to fractures in the crowns of profile was observed at #16 (Fig. 3). Com- teeth #12 and #14 and difficulties in puted tomography (CT) revealed that the mastication. crown of #13 was located close to the alveolar crest of #11, and that the root apex was located 2. Presenting condition lateral to the right piriform aperture (Fig. 4). On his initial visit, a general examination In addition, a pulp cavity in the radiopaque revealed no remarkable issues. An intraoral image at #16 confirmed that the structure was examination revealed residual roots in teeth the residual root impacted in the bone. #14, 12, 23, 24, and 26. Although no mobility was observed in #25, it was extruded, which 4. Laboratory findings may have been because the opposing tooth Hematologic and urine examinations was missing (Fig. 1). When smiling, gingiva revealed no abnormal findings. was visible at #25 (approximately 6 mm) and #13 (3 mm) (Fig. 2). In the mandible, there 5. Clinical diagnosis was a fixed bridge supporting #45 and #46, #14, 12, 23, 24, 26, 33, 34: C4. 17-15, 11-22, pontics on #44 and #47, and abutments at 27, 35, 36: missing #43-32. Residual roots were noted in #33 and #25, 47, 44-32: mild periodontitis #34, but were absent in #35-37. The patient #13: impacted had been using dentures for a long time, and #16: residual root impacted there was some over-eruption and exposure of elongated roots in #43-32. In the anterior tooth region, the distance between the maxil- Clinical Procedures and Outcomes lary alveolar ridge and mandibular incisal edge in the rest position was 6 mm. Overall The roots of #14, 12, 23, 24, 26, 33, and 34 oral hygiene was poor, and mild periodontitis could not be preserved and were therefore was observed in the residual teeth, except extracted. Instruction on oral hygiene and where there were only residual roots. No tris- initial periodontal therapy for the remaining mus or abnormality of the temporomandibu- teeth were provided. lar joint was evident. The following 3 treatment procedures were proposed: 1) removable partial dentures 【版面】W：396 pt（片段 192 pt） H：588 pt 【本文】行数不明（手組み） 10pt 12pt 送り 【図】●図番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std 図タイトルと説明のアキ 9Q ●タイトル折り返し：番号の後（続 く説明の先頭は字下げ不要） ●図説の幅 片段：片段固定 全段：図幅 【表】●番号・タイトル・説明：11.3Q 12.7H New Baskerville ITC Std タイトルと表のアキ 10.5Q ●罫線 表はじめのみ双罫 表中の 罫の太さ 1.411mm ●表中：11.3Q 12.7H New Baskerville ITC Std ●脚注 11.3Q 12.7H New Baskerville ITC Std 字下げなし 斜体は New Baskerville ITC Std Italic（タグは <l>） 半角ダーシはShimoo -（ハイフン）に Y et al.