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"PET" Partial Extraction Therapy Perspective 1

148 Rating(s).

Posted on 03.26.2015 11:55 AM By Jorge Campos In Implants

Here I show a case of PET (partial extraction therapy) which combines well known RST and SS.
Patient with lower incisors with a lot of mobility on centrals. Decided for implant bridge, I checked that laterals had good buccal bone so decided to preserve bone with the two PET techniques. That's why I use the title : PET perspective, cause now is difficult for me to extract a root that could be used to maintain and preserve buccal bone/keratinized gingiva.
No root channel was done on roots.
Thanks for your comments!
Jorge

Healing after 1 week today

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23 Comments

Maurice Salama says on 03.27.2015 08:20 AM

Awesome use of "PET" concepts here....SRT and SS together....As long as we keep them all covered this should provide the best ridge form and long term soft tissue maintenance. Thanks Mo

Jorge Campos says on 03.27.2015 04:29 PM

Yes Mo. PET concepts are begining to show the true potential of site preservation and combined they will work!
What have I done on same situations 3 years ago?
Certainly xtract all roots, implant on same position and try to do some socket preservation with the results we know. Not always enough. On the other hand, I´ve done some RST for prosthetically reasons on fixed bridge theraphy and allways mantained the site perfectly.

Thanks for your comments.
Jorge

Miguel Hirschhaut says on 03.27.2015 08:28 AM

Nice case & beautiful dental photography. I just showed your case to our periodontist. Regards, Miguel

Charles Schwimer says on 03.27.2015 08:43 AM

Jorge. I love the concept! This is how we should view our cases. I have the same opinion as Maurice. It's difficult tell from the images, but do you feel your SRT preparation is deep enough to allow room for soft tissue coverage and restorative needs? In addition, are your implant platforms deep enough IF you were to lose a shield or a submerge root?
Well done! You continue to "show us way" to the future of implant dentistry. Thank you for sharing. Best regards. Chuck

Jorge Campos says on 03.27.2015 04:37 PM

Thanks Chuck, youre observation is right. The implant platform is not deep enough, 1.5 mm deeper would be better! It was a very big surgery, 9 implants on different areas, but wanted to do this at incisor zone. Afterwards I saw that was not perfect...but will work.
RST , I think that are enough deep, but on the case they aren´t, is easy to trim them deeper .
I was wondering to do the endo treatment to the roots, but also wanted to see with the root alive. On the paper I read all of them continue to be vital.
Let´s see. The patient is perfect, no swelling, no pain. He is very surprised with the post operative symptoms. There is no pain fo xtraction!
Thanks for your support.
Jorge

Jorge Campos says on 03.27.2015 04:31 PM

Thanks Miguel, hope he likes it.
Jorge

rocco mele says on 03.27.2015 09:00 AM

Jorge

Fantastic
I still have a difficult time with this. This a unbelievable way to approach this situation. I deal with max and mand incisor problems like this daily. So, ( SRT ) as long as the remaining root has no pathology, vital, rct, sub gingival prep, and covered
we MAY expect decent results?
It sure would save a lot of trauma, bone destruction and stability of the site. Perfect for implants and pontics.

Important to cover with PRF, membrane ( collagen/
BioXclude ) or simple primary closure be adequate ?

Any thoughts and suggestions for SRT would be very helpful. PET doesn't seem to be a good choice for PETS :(

Rocco

Charles Schwimer says on 03.27.2015 09:30 AM

Rocco. As much as I like PET for Humans, I agree PET probably isn't as necessary for most your patients. Unless it is the difference of immediate implant placement(one appoint vs several), I don't think it makes sense for animals. Given their short life span, I don't feel long term resorption complications will be detrimental to your patients. IMO your current treatment protocols are Perfect! Best regards.Chuck

rocco mele says on 03.27.2015 11:24 AM

Chuck

I certainly agree w your analysis. PET is very challenging in the foundation teeth in dogs i.e. PM4, M1, and K9. Now, I can see the value in SRT for many of our extraction cases, especially incisors, palatal root of carnassial and def the mandibular molars. I have done a few on RC teeth ( SRT ) w primary closure and very nice results. My concern, does the coverage of the site make a difference ? ( PRF, collagen, or just primary closure)

Appreciate you thoughts

Rocco

Jorge Campos says on 03.27.2015 04:41 PM

Hi Rocco.
I think RST may be good for PETs also. As you say, won´t loose more bone for the xtraction treatment. Healthy roots of course is not expected to give problems.
A clot + primary closure will work!
PRF is better, cause enhances healing.
Lets see how it develops.
Thanks for your comments.
Jorge

armando ponzi says on 03.27.2015 09:08 AM

Jorge,
very nice case on probably the most difficult mouth area.
Using PET and RST in this area is very interesting.
What implant diameter did you use?
Thanks for sharing.
Armando.

Jorge Campos says on 03.27.2015 04:45 PM

Armando, a 3.3x 16 mm. Torque 40 Nw.
Patient need a removable prosthesis also, and didn´t want immediate load on anterior. This is not a case of aesthetics, it is just to preserve the ridge, as you say on a very difficult area that resorbs easily.
I should have your stents! Implants are not deep enough... but will work on a screwed bridge unit well.
Thanks, Jorge.

armando ponzi says on 03.28.2015 02:27 AM

Jorge,
I'm going to use shortly a 3.0 implant from Xive, Dentsply.
Being so small in diameter it may be of help, solving space problem in that area.
Armando

Jorge Campos says on 03.28.2015 04:48 AM

Yes Armando. I used 3 mm implant as well and is very usefull.
Good luck !
Keep us posted.
Jorge

Ehab Moussa says on 03.27.2015 12:23 PM

Jorge,

Amazing stuff, thank you for showing us the endless possibilities !!

How do you manage teeth for SS, that show signs of pocketing?

Thanks,

Ehab

Jorge Campos says on 03.27.2015 04:50 PM

Ehab, a very nice question!
Simple to answer: just cut the Shield at bone level, no matter the pocket size.
I have posted a 2/3 SS on bicuspid on a case that has no bone on mesial, and cutted the root on the medial to preserve the other part. (Search the case 2/3 SS case on the Forum)
May be this could be interesting to you.
But: no matter the pocket size...unless it is so big that you have a few mm of bone covering a small amount of root!
Thans for asking.
Jorge

Jorge Campos says on 03.31.2015 12:08 PM

You can see today´s healing. After suture removing we can see ridge preservation.
Jorge

Maurice Salama says on 03.31.2015 12:56 PM

Jorge; Is photo #3 Fibrin over the top or CTG? regards Mo

Jorge Campos says on 03.31.2015 02:45 PM

Just PRF only.No Ctg...
Nice closure! :-)

Maurice Salama says on 03.31.2015 02:51 PM

Excellent...I have done the same wit similar results. Thanks Mo

ashok gowda says on 04.01.2015 12:28 AM

Great work as usual Jorge, compliments.

In how many weeks you got the soft tissue closure on submerged roots. Do you think after submerging, the level of tooth platform will influence the soft tissue closure on the root surface. Did you raise the flap. Thanks, Ashok.

Jorge Campos says on 04.01.2015 04:19 AM

Hi Ashok, thanks for your comments.
No I don´t raise a flap for closure, because I don´t want to change mucogingival line, and don´t want to stop blood supply to buccal bone. It is not necesary to raise a flap for root covering. Just trim the roots to bone level.
After 3 or 4 weeks roots must be covered, if not, just trim again a litle deeper.
Pontics will not make pressure to the area, just a soft contact and the keratinized tissue will be stable.
Thanks again,
Jorge