"SRT" Submerged Root Technique in Anterior Maxilla

471 Rating(s).


Posted on By Maurice Salama In Anterior/Esthetic

Patient presents with severe root resorption in area of maxillary left lateral incisor. CBCT reveals exceptionally narrow ridge and thin bone which would require significant bone augmentation. Patient desired alternative options? SS, SRT or Bone Augmentation. thoughts and comments welcome, Dr. Salama

Shield Technique
PA resorption

Preparation of Root
3mm depth of prep


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30 Comments

2 months

healing front view
with temp


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5 months

5 months
Framework tryin


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5 months and PA

PA Framework
Smile with temp at 5 months


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The papilla between the lateral and the canine changed it's position. Why is it?


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Mo, a perfect example for RST. On the other hand a SS also would do the same but in a more expensive way.
Did you discuss with the patient the posibility of a bridge using first bicuspid (dark color), cuspid and lateral as an extension?
Thanks for posting.


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Mo. Excellent choice! CONSERVATIVE PRESERVATION. All other options remain available if necessary. Beautiful case as usual. Thank you for sharing. Best regards. Chuck.


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Preop CBCT...hour glass shaped anatomy and thin ridge.

Preop CBCT
With implant simulated


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really nice case!! smart solution for the patient


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Thank you Sebastian....I think it is a nice and effecient solution that preserves the ridge in the least expensive and lowest morbidity. Dr. Salama


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Mo,
Really didactive case and great clinical execution.
I would observe that once more correct initial data and planning are mandatory for right plan addressing.
And a thought: I would have included the bicuspid and make a pontic solving an esthetic problem and a functional one (cuspid have high risk of fracture post endodontic) and have a more stable pontic in time.
Best regards.
Armando


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Armando; The lifespan of mesial cantilevers off Canine teeth are well documented yet, I do not know when the canine has RCT? I prefer to avoid the 1st bicuspid due to "high" fracture rate....but here I think you and Jorge and RIGHT. Regards Mo


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Great work Dr. Maurice. Do you always prefer to cover the submerged root surface with CT graft? thanks, Ashok.


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Great case! I have several questions for you:
1. What is a long term prognosis of SRT?
2. When you reduced #7 did you follow the same bone outline to preserve Biological width?
3. Do we have to do RCT on SRT technique? Why "Yes" and "No"?
4. Why not to do pontic site at the time of SRT?
Thank you! Gregory


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thank U for sharing.

No RCT for submerged root, grate guess work which disregard majesticly the Shilden basics principles of eco.

I love the way U left the first premolar out of the basic aesthetics my mistress which work in esthetics think that could be a new trend.

for me what ever U do is very inspiring and seriously I can't imagine my life without dentalxp!!!

I love U and SHANA TOVA
nel


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Thanks Nel.
No RCT needed. See my 2 Part presentation here on Dentalxp.
http://www.dentalxp.com/video/advantages-the-root-submergence-971170.aspx?locale=


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Gregory. All your answers are RIGHT here at Dentalxp.com. Go to the link for 2 Part lecture that answers each question you have in GREAT detail.
http://www.dentalxp.com/video/advantages-the-root-submergence-971170.aspx?locale=


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Why did you avoid endodontic treatment of the submerged root? Thank you


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Claudio;
No RCT needed. See my 2 Part presentation here on Dentalxp. http://www.dentalxp.com/video/advantages-the-root-submergence-971170.aspx?locale=


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Hi Mo, here is a RST with no endo treatment.
24 hs after the surgery. Not yet covered. Let´s see evolution.
Patient painless.
Regards,
Jorge


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Hi Jorge,
I'd like to share some thoughts about case you show above: if after 24 hours you have no clot than it could mean that healing may be longer or incomplete. Probably dental wall around need to be deeper allowing blood to invade tooth base and promote either clot formation and epithelium above to have a perfect closure.
Pain is usually not present as open pulp doesn't but it could veicolate at the apex germs and may experience a late apical infection.
Nice always to see your cases.
Armando


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Hello Jorge.
It seems that there's been left a thin enamel wall on the labial (and maybe distally as well) that is supra gingival.


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Jorge;
Always challenging the "old" ways. I do respect you "pushing" the envelope. Typically, we recommend either CTG or Flap advancement and PRGF/PRF for closure of exposed pulp. Having said that, in the old literature back fom the 60's and 70's what you show was done and then dentures were relined over these exposed pulps. Interestingly only 49% developed periapical pathology??? Let's follow your case?? Without pressure from a denture.....the tooth may retain vitality. Mo


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Armando, Konstantinos and Maurice, I do agree with you, and I ussually cover the root with ctg or PRF. On this case the root was covered by prf but...went alone. I do think that the ephitellium will cover the root surface. If not, I´ll grind a little on final prosthesis fase.
I do really think that a vital pulp that is exposed on this way, not in a cavity of a dental caries, is able to resist bacterial penetration because the tissue is alive and will make a micro clot that eventualy will close with dentin.
As Mo said, let´s see evolution of the case....
Here I show you another diferent case.
Regards.
Jorge


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Well said my friend. Mo


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This is a SRT using DFDBA over exposed root.

pre treatment/baseline/4 month healing
pre treatment/baseline/4 month healing


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Wow...why did you bone graft over exposed root? Mo


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Mo. I use DFDBA because I considerate it to be particulate collagen in nature with trace amounts of BMP present. The primary purpose is stable clot formation to facilitate both hard and soft tissue proliferation into the site. It is non invasive and in my hands seems to be superior to adding nothing( which also works). Thank you for your comment and question. Best regards. Chuck.


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It is wonderful example that "SRT" described by Dr. Maurice Salama works. Nice case except for the Prosthetics handled. I am a Prosthodontist in MA and with my experience through all of these years of my career, I can tell you that a cantilever supported just for one tooth like at your case is in a long or short term a very slow extraction of the tooth abutment or a fracture of the post as described by one of the previous commenters. Any tooth treated endodontically is a high risk of getting fracture so I would have taken tooth #5 as a second abutment to support the cantilever, improve the connector of the cantilever which seems to me short and weak making the cantilever in high risk to get fractured, we can also improve the aesthetics and a better prognosis of the whole prosthesis. M or D cantilevers do need at least two abutments support, otherwise we are coming to the old techniques and literature described by the British Dr. Alan Polson many years ago, placing 2,3 or more cantilevers having a lot of failures in a long term.

Thank you,
Gustavo Perdomo, DMD, DDS, CAGS.


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Gustavo; Welcome to the Forum. A good point of discussion. I am always concerned about adding a 1st premolar to the case as we tend to have a higher risk of fracture of that tooth as well as the periodontal management of the mesial fluting of the root. I will keep us posted on the case and hopefully all goes well for this nice patient. regards Dr. Salama


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Thank you Maurice.
I love these discussions.
Best


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