PET - socket shield and post ex implant placement mandibular incisors

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Posted on By snjezana pohl In Implants

Patient with chronic periodontitis is referred for mandibular incisors extraction and implant placement.
Initial periodontal therapy is carried out. Patient wanted to start with mandibular incisors. The treatment is in progress.
This surgery is done one year ago. I would do some aspects rather in different way today, but we have at least some points for discussion.


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Ha ha ha!
Snjezana, a beautifull video with excellent result.
I love the crown..
Question: why didn't you do RST on central incisors? Could have been done?
Technique is perfect, but I allways use high speed for tooth cutting. Do you find that hand piece is better?
I try to remove lingual part with extremelly care. With only lateral forces, avoiding any lever on buccal shield.
I don't pack nothing inside the socket now.
Thanks very much for posting.



As I`ve said, I would do some things in different way today.
You missed the only one point that I would change nowadays: Densah.
RST: The central incisors were mobile and I didn`t dare to perform RST. I would do it today. Except for the right central incisor with a deep pocket.
Like Richard, since my OMS training I am attached to hand-piece. But I protect and push gingiva with gingiva protector.
One year ago I have not used Densah, so I performed a biological drilling. And placed this autogenous bone into the gap. I don`t think that it`s vital, but this habit is stronger than me. At least, no Xenograft and Chuck won´t warn me.
I thought, you will like the crown`s salto mortale:)
Thank you for your valuable points, see you soon


Hi Snjezana, now I understand: mobile roots don´t qualify for RST.
Even your training as OMS you should try high better for me.
Thanks for your answers!
See you soon, Jorge.


Jorge, I`ve tried, but there is one advantage of hand-peace and Lindemann bur: the space between two root pieces is larger and that gives more manipulation space.
42 days and 6 hours


Congratulations again on your case, beautiful. I like the results very much. Very solid decision making process and I am sure the results will remain better as time goes by. Would you consider an immediate loading on a case like this? What is your initial maintenance protocol, after the restoration is in place?
I admire as well your movie production skills!! Bravo!!
Thanks for sharing,
All my best


Dear Manuel,
it`s always nice to have you on forum.
In cases like this we prefer immediate provisionalisation. This patient dropped in on a very busy day for control after scaling and wanted to start with implant placement. So we applied “plan B”: fixed provisional bridge on central incisors.
What I especially like is superposition of CBCT after implants osseointegration on CBCT before teeth extraction. Nothing is lost. I believe it`s going to be stabile long term.
And - I enjoyed editing this video. Autodictat me was fighting to determine a thumbnail (impossible), viewing thousands of you tube “How to…” and learned some useless tricks. It has taken the whole Saturday night. Finally, I overcrowded video with jumping people and monkeys, animated emoticons & Co, only to delete it on Monday:).
Thank you for your kind comment



very nice work also and I see that light Clint Eastwood you were trying to transition from the actor ( surgeon) to a successful movie producer.

I will keep inquiring about making PET Burs for the straight handpiece - and like you said when you're raised on the straight
it becomes no more than a paintbrush and like Clint Eastwood's success it's just a transition in time




Richard, my soul mate.


Great skill!!! You make something that's very technical look very simple


And harvesting bone plates from tori mandibulares with 3D reconstruction is easy:))
Thank you, Naheed,it`s good to have you on forum.
Best regards


Snjezana. Nice case and video! I also like the crown effect:-). In some instances if mobile teeth are stabilzed SS or RST is possible. It works if you have the time to wait. See you soon. Warmly . Chuck


Chuck, finally. Now I can go to the bed:)
Yes, I`ve also made this experience that mobile teeth can be used for RST. SS teeth had also mobility grade I-II.
See you in 40 days and 4 hours!


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