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"PET" SRT Submerged Root Pontic Technique
Posted on 10.20.2016 01:09 PM
By Maurice Salama
In Implants
Patient presents with fracture to gumline of LL Lateral incisor. Patient has previously had 2 Unibody implants placed to replace Lower central incisors. No room between implant and adjacent canine for the placement of even a 3.0mm implant.....Decision was to perform cantilever bridge off stable canine (with erosion defect) with SRT on lateral incisor. Small CTG from palate utilized for pontic development. What say the XP troops? regards Dr. S
PA preop
SRT PET Kit bur
PET Kit Apron-Shield
Depth check
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26 Comments
Charles Schwimer says on 10.20.2016 01:24 PM
Mo. Excellent choice of Tx! What are your thoughts on the potential need for Endodontics for the cuspid? Perhaps #26 was restorable? A crystal ball would be helpful :-). Well done. Best wishes. Chuck
Maurice Salama says on 10.20.2016 02:02 PM
Chuck; I think that the crown lengthening required on #26 to gain a ferrule may have put the THIN bone on distal of implant at substantial risk....as for the canine, I think we will keep our eyes out but it tested vital so far...
regards Mo
Jorge Campos says on 10.20.2016 02:23 PM
Hi Mo, without any doubt this is the correct treatment.
Ctg, and also could be PRF, will develop a good keratinized gingiva on ridge. This "simple" but efective treatment avoid loosening bone besides the implant and preserving keratinized gingiva on area.
Please keep us posted on final result.
Regards
Jorge
Maurice Salama says on 10.20.2016 02:49 PM
It is OFTEN what we DON'T do that is CRITICAL....."no extraction no collapse" regards Mo
yiannis vergoullis says on 10.20.2016 02:51 PM
Beatiful case and photography! I think extraction on this site would be detrimental.
This is so much easier and better approach for the patient.
Yiannis
Carl Choi says on 10.20.2016 03:05 PM
Dr Salama,
It looks as though you maintained a lingual shield also? Or does it just look the way in the photos?
Thanks,
Carl
Maurice Salama says on 10.20.2016 03:34 PM
Was not completed yet...but removed...Dr. S
Erik Andersson says on 10.20.2016 03:06 PM
Jorge, would you comment on how you place the PRF over submerged root to allow keratinized overgrowth? Great case! Thanks Mo. Erik
Jorge Campos says on 10.20.2016 05:25 PM
Erik, just pack PRF on top of RST and a cross suture will allow the sourrounding gingiva cover the root espontaneously.
Regards.
Jorge
James Albani says on 10.20.2016 03:29 PM
Is there a lingual shield??
Maurice Salama says on 10.20.2016 03:35 PM
No....just the image taken before it was removed.
Gregory Mark says on 10.20.2016 08:48 PM
I know one of the Italian dentist described a technique where he partially pulled a tooth out of the socket, waited several month and the restored it. Do you think his method of treatment would be appropriate here? Gregory
ashok gowda says on 10.20.2016 09:54 PM
Hi Maurice, perfect treatment plan and execution. After doing couple of cases by following your standard protocols on this treatment plan, One aspect is not very clear to me even now, When and how will you decide -- to touch or not to touch the root canal of a sub merged root ( Endo or Cvec pulpotomy, etc, etc). Regards, Ashok.
Maurice Salama says on 10.21.2016 08:41 AM
Ashok; I prepare down 3mm in depth regardless of canal vital or RCT. Then irrigate and if vital I simply close the flap and/or add CTG....with non-vital I seal access with glass ionomer and then the same as above. Dr. S
Gerald Benjamin says on 10.20.2016 10:33 PM
Hi Maurice;
Did you consider removing the implant crown on #25 and placing a new implant crown with pontic instead of cutting another tooth?
Just wondering.
Regards,
gerald
ashok gowda says on 10.20.2016 10:50 PM
Thats a great idea Dr.Gerald. Regards, Ashok
Maurice Salama says on 10.21.2016 08:42 AM
Gerald; A very good option as well. The patient did not wish to involve the previous restorations and was aware that the canine would require some restorative work due to severe erosion. regards Maurice
Matthew Giulianelli says on 10.21.2016 05:42 AM
Dr. Salama, is there any consideration to if the lateral might have a periapical lesion? Let's say a tooth that was an otherwise good candidate for RST DID have a periapical pathology, what would you do?
Maurice Salama says on 10.21.2016 08:43 AM
Matt; I would do the RCT and then SRT. Dr. S
andoni jones says on 10.21.2016 06:34 AM
Hi Maurice,
Why not root submergence instead of pet?
I would also have Gerald's as first option, unless the canine needed a crown, in that case your solution is the ideal one.
Regards
Maurice Salama says on 10.21.2016 08:43 AM
Andoni; This was root submergence....not socket shield. Dr. S
Charles Schwimer says on 10.21.2016 06:59 AM
Another possible solution could be Endo - Rapid Extrusion with Fiberomy elongation and restore #26. No adverse impact on adjacent implant or tooth.
http://online library.wiley.com/doi/10.1111/j.1708-8240.1990.tb00615.x/abstract
snjezana pohl says on 10.23.2016 10:17 AM
Chuck, this link doesn`t open. Could you please check it?
GF
Maurice Salama says on 10.21.2016 08:44 AM
Perfect Chuck.......always thinking. I proposed that but patient is 71 years old and lives in Arizona....he wanted quick and fast resolution. regards Mo
snjezana pohl says on 10.23.2016 10:29 AM
Dr. Salama, thank you for sharing this beautiful managed case.
It is so important to share not only techniques that we utilize, but the daily decision making process. A vividly discussion shows it.
I like your solution.
3,0 mm implant insertion was not possible - how about a mini implant?
Best regards
Snjezana
Maurice Salama says on 10.24.2016 03:36 PM
Thank you Snejzana...no unfortunately the space between implant and canine root was 2.7mm on CBCT....Thanks for your kind words and I also enjoyed the discussions....regards Dr. S