What is the best approach?

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Posted on By Mehron Haidari In Implants

Hello there. This is a 21 yo female with failed ant max teeth. #8 is missing, #7, 9, 10 failed rct and faulty restorations. Hopeless. what is the best course of action. She is only 21. I have done many socket shields but not more than one tooth. Also concerned about cleaning the granulation tissue. Other option is to ext, clean up, graft, and follow D. Buser’s delayed implant placement. One main problem is the teeth are malpositioned. Socket shield keeps the soft tissue at the same place. Any suggestions?


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Your approach by Professor Daniel Buser is a good one. One thing you might wanna consider is to open VDO in which you need to restore one arch at least, finances ok?
In my humble opinion have the casts mounted and decide the fate of your treatment with diagnostic, additive, anatomic, and aesthetic wax up. Whether digital , or manual. That would take lots of guess work out of your equation.
If extracting 7,8,9,10 only and no other work, and want to graft, make sure you have beautiful provisionals to support soft tissue.
Under no circumstances do I recommend xeno or mixture. Stick with allograft or synthetic bone plus PRF for sticky bone.
Your hardest task to keep 7x10 bridge would be your soft tissue management.
Alternatively you can socket preserve 8; and 9 with xeno, for a good volume, 7, 10 sticky bone, make an Essex from canine to canine with beautiful ovate Pontic and continue your implant journey. If you clean well, there is no need to wait for implant placement. Hope this help a bit. Best of luck.
Seyed Masood Shariati


For the most part, I do agree with the previous suggestion.
Since the patient is so young, I do not recommend the implant placement either at this time or whitin the next few years! How the patient looks like now and 10 years from now will be significantly different, therefore delaying the placement of implants is paramount. If orthodontic treatment is needed and 7,8,9,10 will be missing, an anterior provisional could be a challenging step. One option could be 2 cast frameworks, each canine supporting the missing centrals and laterals, opaque the framework and composite build ups. This will enable to do cosmetic modifications if/ as needed during orthodontic treatment. Once orthodontic treatment is completed(if done), a new metal Maryland bridge framework with porcelain can be done, review esthetics after a few years.


The extraction of a tooth leads to a cascade of events which results in resorption of the alveolar bone around the socket. The buccal bone loss that occurs postextraction leads to vertical and horizontal bone loss. It requires complex hard and soft-tissue reconstruction to achieve esthetically pleasing results in such cases. In the socket-shield technique (SST) the root is bisected, and the buccal two-third of the root is preserved in the socket so that the periodontium along with the bundle bone and the buccal bone remains intact. A classification of SST technique is proposed depending on the position of the shield in the socket. This classification is required so as to help in understanding the preparation design and the role of shield and in maximizing the usage of the shield to achieve best possible esthetics in immediate implant placement sites.


Your methodology by Teacher Daniel Buser is a decent one. One thing you could want to consider is to open VDO in which you have to reestablish one curve in any event, funds alright?
As I would see it have the projects mounted and determine the destiny of your treatment with demonstrative, added substance, anatomic, and stylish wax up. Whether advanced https://rdmdental.com/, or manual. That would remove bunches of mystery from your situation.
If extricating 7,8,9,10 just and no other work, and need to join, ensure you have delightful provisionals to help delicate tissue.
By no means do I suggest xeno or blend. Stay with allograft or engineered bone in addition to PRF for tacky bone.
Your hardest assignment to keep 7x10 extension would be your delicate tissue the executives.
On the other hand you might attachment at any point safeguard 8; and 9 with xeno, for a decent volume, 7, 10 tacky bone, make an Essex from one canine to another with delightful praise Pontic and proceed with your embed venture. In the event that you clean well, there is compelling reason need to hang tight for embed situation. Trust this help a little. Good luck.
Seyed Masood Shariati


Henry Schein