Immediate Placement --Densah Bur

final restoration

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Emil. Yes you were able to place an implant with nice ISQ values and restore in 12 weeks, BUT IMO this is NOT an OPTIMAL result. Look at the loss of IHB on the distal of #7. In addition, there is now a root proximity issue in this region as a consequence of the crown contour. As much as I admire your work, I feel you took your "eye off the ball" on this one. Maybe I am wrong, but I believe this result could have been avoided. What are your thoughts? I think it is important for us to discuss your flap design, implant position, and crown contour. After all this is an educational forum. Thank you for sharing. Best wishes. Chuck

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Chuck

Optimal?--- could it have been more ideal---of course.

Do you think this will last her lifetime?---she is 78 years old.

I would prefer to do a full smile makeover but could not convince her of the benefit.

I am always open to constructive criticism of my work!

Thank-you for your commments

Emil

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At 78 maybe giving her a tooth in 12 weeks was the priority:-).

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Chuck

As you so wisely stated this forum is educational and this sums it up!

words of wisdom

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Hi Emil. Seeing how it is Monday, could you please comment on your selection of implant position, flap design and crown contour. There are many on the forum with less experience than others. Best regards. Chuck.

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Implant position was determined by the socket of the extracted tooth. I do not know where else I could have placed the implant as an immediate. Open to retrospective recommendations.

Flap design

I probably could have done a better job of papilla preservation or simply extended the sucular incision mesial and distal before making my vertical.

Implant position

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Concerning crown contour

Not ideal but neither was the old crown position.

Tissue getting better over time.

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Great documentation! Is the crown cement or screw retained? IMO the angle of the implant would require a custom abutment to allow more space for the papilla to exist. In addition, a CTG would help. Thank you for the additional images.Warm regards. Chuck

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Question to Chuck and Emil. Can you discuss how the flap design would be more optimal for the benefit of our forum readers with less experience designing case like this.

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John. As a general rule, I try not interfere with the integrity of the papilla during extraction. However, if a vertical incision were necessary for regeneration, I still would avoid reflection of the papilla. Especially in the lateral incisor region. John, I believe you are an experienced Periodontist. What are your thoughts? Best regards. Chuck

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Thank you Chuck...I am a GP and have done a number of implants but have more limited experience in the esthetic zone. I appreciate your reply and your contribution to this forum. I will utilize these suggestions. Regards John

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1 year post

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Emil. Go figure. Mesial drift at 79 years of age! I must admit didn't see that one coming. Thanx for the update. Best wishes from OWS. Chuck

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Emil,
Great stable 1 Year result.
SS seems to work very well in any hand and the Densah drill highly improves the predictability of procedure.
See you soon in Orlando. Just One day left for this great learning share about osseodensification.
Armando

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