Immediate implant placement #8 Video

Dual Zone Socket Management....beautiful work. My question is are or should we be concerned about the SIZE of the GAP between implant body and buccal plate here? It seems quite larger than 2.25mm? Did you consider Socket Shield as the root appeared to be intact on labial. Do you have some PA radiographs or CBCT images pre and post to add? Thanks Dr. Salama

Reply

About the PET, I didn't thought it was the best approach for this case, because the pacient had a endodontic perforation on de cervical third or the root, and she also had external root resorption. It would be nice to know your experience in cases with external root resorption and PET.

About the gap size, from my point of view I always try to generate a gap of at least 3mm, because it allows to fill the entire gap with the bone substitute and have a good amount of this xenograft with the idea of compensating the volumetric changes caused from the bundle bone resorption.

If I have a bigger gap then I will have a bigger amount of bone in the buccal aspect of the implant. There is an article of Dr. Da Rosa that shows a "guide" to select the implant diameter based on this gap concept.

And I used a morse connection that allows me to have a correct emergency profile.

I always try to put a little bit of auto bone graft that I get from the drills over the surface of the implant, and then the xenograft.

Greetings from chile
Sebastian Bravo Céspedes

Reply

Great video Sebastian.

Was the implant loaded, or you bonded the crown to the adjacent teeth?

Also, how deep was the implant placed?

Regards

Reply

I didn' load the implant, I made a maryland with the pacient tooth.
I put the implant 5mm apical to the gingival margin, because I want 4mm of biological width and the tooth was 0.5 - 1 mm shorter than the contralateral (tooth number 9), and I used a morse connection that allows me to have a correct emergency profile.
Regards from chile

Sebastian bravo

Reply

Sebastian, congratulations on a beautiful work done. I like your approach. I think the provisional restoration is a key element in maintaining the graft stable and also helping the maintenance of the ridge dimensions.
Do you think the same results would be obtained only with CT graft and the provisional, with no bone graft in the gap?
Thanks for sharing,
Manuel

Reply

thanks for your comments manuel , i think , based on the studies of chu and tarnow that if i did not fill the gap im gonna have lost of volume , and in my point of view i want to be sure to have as much bone as i can in the surface of the implant to protect it in the future and prevent bone lost and periimplantitis process . regards

Reply