Anterior Implant Case - Decision Making

26 Rating(s).


Posted on By Dattathri Malyavantham In Implants

Patient age : 26 presents with trauma to #8 ( Elbowed during basket ball game).
Tooth #8 with RCT treated 12 years ago.
Exam : Cervical fracture of the crown and gingival abscess.
X-ray/CBCT attached
Class 1 type, thin buccal plate, no Periapical lesion.
Tx Decision:
Extraction +Immediate implant/Bone graft and immediate temp using patient natural tooth. Micro surgery for gingival tissue. Post healing Soft tissue grafting consideration. Strong possibility.
Like to hear your feedback.
Thank you
Datta

Prepop
Preop xray

CBCTLateral view
CBCT planning


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8 Comments

Post healing photos Restorative - Zirconia abutment and Emax crown. Tissue response satisfactory( not Exact wanted). Patient happy with the outcome.

Implant with natural tooth
Final outcome


Reply

Good job.

Pt. is 26 yrs old, thin buccal bone -- ideal case for socket shield, IF you believe in that concept.

How is the occlusion, why lower anterior supra eruption?.


Reply

I am limiting Socket shield to cases -when luxated with zero mobility of the root. If incorporating SS must have minimum 1mm space from implant fixture to residual root(IMO). So I can still have bone interface and not root interface to implant fixture. Occlusion is not bad with minimal overbite .See the image below. Ortho could help. Appreciate your questions. Best, Datta

With abutment


Reply

Thanks for your answers. Tooth can fracture even without zero luxation. We all know about that. If it does then we can think about socket shield as one of the appropriate option. Luxation part was missing in your case history it says just about fracture , hence i thought in the line of shielding.

Regarding the gap between fixture and the root surface in shielding technique, central incisor socket anatomy is appropriate in most of the cases. Right now you got very good result without shielding. Follow it if it's possible just to see how the buccal contour exists over a period of time. Ortho will definitely help in this case. Regards . Ashok


Reply

Really nice result! I did a case like this (without the tissue trauma) with Dr Salama years ago using the patient's own tooth for the temp as well. Now lets see how the tissue responds but your procedures at this point look great and has set you up for a terrific final result. I believe maintaining the interproximal bone on each side will ensure tissue health.
Great job!
Jeffrey


Reply

Jeff, thank you for the response. Long term results pending. Will post in future. At present one year is good. Happy New year Datta


Reply

Look great !
Can you tell me the detail about the burs used to cut for the buccal shield


Reply

Thank you Tina!

Salvin dental makes the surgical bur
700 xxl , my go to bur with root removal or
socket shield cases.
It is a carbide , please use with finesse.

Best
Datta


Reply


PET Kit
Salvin