Incomplete Root Removal for Socket Shield

The tooth at #6 was used clinically as a lateral incisor (Fig.1: #6).  When the RPD is removed, the buccal gingiva looks healthy (Fig.2).  After socket shield is presumably finished (Fig.4 ^), osteotomy is initiated in the palatal aspect of the socket (Fig.3,4).  The trajectory is acceptable (Fig.5), but the presence of the apex of the root is ignored (Fig.5 *) until a 4.5x15 mm implant is placed (Fig.6, 50 Ncm).  Since there is no apparent periapical radiolucency, the radicular apex is not intended to be removed.  The implant remains palatal (Fig.7).  A definitive abutment (4.5x5(3) mm) is placed with .5-1 mm bone graft (Fig.8 *, mixed with autogenous bone and Osteogen).  An immediate provisional is fabricated to hold the partial and the bone graft in place.

The patient returns for definitive restoration 3.5 months postop (Fig.9-12).  The bone graft does not stay between the socket shield (Fig.11 arrowheads) and the implant.  Considering the position of the residual root (Fig.1) and clasps (Fig.3,7), make the crown looks like a canine or lateral incisor with a possible mesial diastema.  The gingiva looks healthy 14 months post cementation.

Return to Upper Canine Immediate Implant Technicians #18 27

Xin Wei, DDS, PhD, MS 1st edition 02/02/2016, last revision 02/03/2019