P. E. T. Partial Extraction Socket

124 Rating(s).


Posted on By Alberto Miselli In Anterior/Esthetic

P. E. T.
When we decided to preserve the labial volume, for aesthetic reasons, with the maintenance of the labial bone, through a socket shield, the procedure has very specific premises: the tooth must have a periodontal condition full of health, the periodontal ligament must be healthy!. On the other hand, if the implants are contiguous, as in this case, # 8 and # 9, where we want to preserve the height of the interproximal papilla, the shield should extend proximally, following the contour of the gingival margin. We know that the preparation is very delicate and leaving 1 mm of shield is necessary so that there is a jumping gap of at least 1 mm. Concerned for about height, that shield must be 3 mm deep, to create a biological space, avoiding the exposure of the radicular fragment. The gap is filled with allograft material and in my protocol it is mixed with Liquid APRF (according protocol of Dr. Choukroun). Fill the gap after implant placement, it is very difficult, so in my routine, I prefer fill the socket with allograft material and then, with the last drill, at very low speed (30-50rpm), NO IRRIGATION. I think this is the best way to fill the gap. In this case a conical connection implant was used, because it is a very stable connection avoiding micro movement and pumping effect. It was placed 1 or 2 mm below the root fragment. In this case, due to having defective metallic-metal crowns of lateral incisor, they were removed and a provisional with ovate pontics was made, emphasizing the distance between the pontic and the implant, maintaining a prudent separation so as not to produce any contact to the implant. The subcritical zone of the pontic was made with resin flow with high polish.

Baseline #8 and #9
Proximal and buccal shield preparation

3 mm depth shield preparation
Filling the socket


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8 Comments

Great Case. What was Shape of Shields? C shaped? What system did you use? Brassler PET kit?
Thanks Maurice


Reply

Thank you Maurice. Yes I used C-shape and Brasserie kit.

Pre Qx
post Qx


Reply

Thank you Maurice. Yes I used C-shape and Brasserie kit.

Pre Qx
post Qx


Reply

Please add images as case progresses. Maurice


Reply

Of course!!!


Reply

Hi
Have the implants been placed at a safe distance from the nasal floor?
Cheers


Reply

Dear Todor it is just a periapical X-rays took after surgery. We are going to order a CBCT.
I checked the patient, she came back today (4 days post Qx) and she doesn’t have any sensation. Best regards
Alberto Miselli


Reply

Deep understanding of critical and subcritical zone makes you to PET eXPert. Besides apex and root canal removal it is the most critical part of PET.
I find socket shield challenging for the cases (mostly deep bite patients) where the palatal bone wall is 2-3 mm deeper than the buccal. How do you proceed in this kind of anatomy, Alberto?
Great case, thank you for sharing!
Best regards
Snjezana


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