Immediate post-extraction loading with Conical Active and bone expansion technique

Dr. Jaime Franco - Managua (Nicaragua)
With the help of Dr. Daniela Viales and Dr. Laura Vargas

A 38-year-old woman undergoing orthodontic treatment requested an evaluation for the possible installation of an implant in the area of tooth 21, which had previously undergone endodontic treatment with insertion of a metal post, reconstruction and metal-ceramic crown.

The patient presented with a fracture below the amelocemential junction, ruling out the possibility of reconstruction. In addition, there was severe collapse and resorption of the vestibular cortical bone due to torsional forces.
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To address this situation, the option of placing an internal tapered connection implant immediately after extraction was adopted. Specifically, a MaCo implant Conical Active to make maximum use of residual bone structure through the application of the expansion technique to manage buccal collapse, thus ensuring optimal utilization of available bone tissue.

Extraction was performed with extreme precision using fine levers, followed by careful cleaning and curettage of the socket. The creation of the new socket for implant placement required a series of steps. Initially, an active-tip drill was used, which then took on the characteristics of a 2.2 drill due to its conical design.

Next, a fine expander between 1.8 and 3 mm in size was used, following the methodology proposed by Professor Dr. Alejandro Padrós, managed with the utmost care. Each expander was placed in the bone for at least three minutes in order to facilitate the return of blood flow, improving bone flexibility and reducing the risk of fracture.
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Then, after the waiting period, a second expander was placed, with a size between 2.8 and 3.3 mm. Next, the implant was placed in the prepared socket. Regeneration was completed through the use of a pericardial membrane, followed by suturing.

A temporary crown identical to the preexisting one was attached to the adjacent teeth and orthodontic wire by ligation.