Guided Socket shield and Apico on Fractured Central Incisor

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Posted on By Maurice Salama In Implants

Patient with High Estheitc demands presents with oblique fracture of right central incisor and peri-apical abcess. Wants optimal esthetic result. We attempted Guided SS/PET & Apico with Custom Contour Helaing abutment to maintain tissue levels in optimal form. Thoughts? Comments welcomed. Dr. Salama

Oblique fracture found during SS prep
Sagital view of apical abscess and implant plan behind shield

Initial SS prep and removal of Palatal root
PET/Apico Guide


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15 Comments

Removal of fractured portion of SS from bone crest.

Facial Oblique fracture at bone crest removed
SS after removal of fractured segment


Reply

great work. any reason for no immediate temp? also was the custom healing abutment done with composite? exquisite surgery. regards. bf


Reply

Brian; Great question, Patient did not want "shorter" central incisor during transitional phase as we explained it must be "out of occlusion", she chose an Essix instead. As for Custom Healing abutment, yes, composite but can be done with acrylic as well. We prefer composite resin light cure and finish and smooth, polish out of the mouth. Dr. Salama


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that makes sense. thanks for posting and teaching as always


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Great work as usual here Maurice. I do custom healing caps all the time, they are great. Any advantage of guided vs free hand in a case like this? Would you encounter buccal shifting of implant? Regards my friend


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The Guide here assures the minimally invasive approach and maximizes accuracy. Thnx Dr. Salama


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Hi Mo. Nice execution with the aid of the stent. Truly a step forward...
Did you fill the gap? Fid you used PRF?
Post op CBCT?
Thanks for sharing.
Regards
Jorge


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Only PRF my friend...


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Thanks MO! It´s what I´m doing... Regards Jorge


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Team Atlanta is again two steps forwards. Amazing!
One question, Maurice: the incision is in mobile mucosa: did you have a problem with soft tissue wrapping around the bur during apicoectomy? This is what happens to me with small incisions in the apical area..I need to keep tissue away with two elevators. Does the guide fits firmly to the base and the soft tissue doesn’t interfere with the bur?
Congratulations for the plan and execution, thank you for leading the way!
Best regards
Snjezana


Reply

No issues....incision was just bekow MGJ. If flaps are any issues you can suture the flap to coronal part of guide or use mini elevators...the guide was a remarkable adjunct IMO for a minimally invasive procedure. Regards Maurice


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This patient is very lucky to have met you!! A lot of science and knowledge coming together with good hands to give him optimal esthetic and fuctionnal results.. The guide doesn`t seem to be ideal for irrigation of area. Do you have the assitant complement with syringe irrigation ? Is there a better design of guides out there ?


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The window displays the tissue and implant so that irrigation can be provided by the assistant. The design of guides is up to the creator. Many different designs can be made. Thanks Dr. Salama


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Awesome display of skill and technology. It’s all in the planing. PET / apico combination is a useful PET adjunct and in reality simplifies otherwise more challengingly cases.


Reply

Thanks Chuck. Agree completely....Mo


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