41994_Australasian_Dentist_100_EMAG

CATEGORY LINICAL

u Irritation of the marginal gingival due to repeated re-cementation attempts. u Slight marginal recession at 21 u Stable, complete dentition and occlu sionwith adequate overjet andoverbite. e radiographic (Fig. 3) and Cone beam Computed Tomography (CBCT) (Fig. 4) sections showed: u A relatively prominent incisive canal u RCT obturation short of the apex u Blunting of the root u Intact buccal plate u Lack of apical pathology u Adequate apical native bone Along with intra-oral scanning for Surface Texture Lithography (STL), all diagnostic information was put into a 3D implant planning software (R2GATE) to plan the implant in the ideal position, and fabricate a surgical guide. On the day of surgery, the occlusal view (Fig. 5) captured the bucco-lingual position of 21, as well as the buccal contour of the tissue. After anesthesia, the broken crown was carefully removed (Fig. 6). e remaining root was reduced to a socket shield using the Partial Extraction erapy kit (MegaGen) designed by Dr. Howie Gluckman. First, the root length was measured on the CBCT, which helped guide the sectioning depth. Once this depth was reached, the cut was extended mesial to distal to separate the buccal portion of the root from the palatal portion (Fig. 7). e palatal portion of the root was gently luxated and removed (Fig. 9), then the remaining buccal portion was carefully trimmed to the proper dimensions and retained as the “socket shield” (Fig. 8). Next, the surgical guide made by the R2GATE programwas positioned (Figs. 10 & 11), and used tomake a pilot drill osteotomy (Figs. 12, 13 & 14). e R2GATE guide was also used to complete the placement of the implant (AnyRidge, MegaGen) at the proper angulation, position and depth (Fig. 15). e implant position was veri ed to make sure it was not engaging the buccal root fragment (Fig. 16). A standard healing abutment was placed and the jump gap was grafted with Platelet Rich Fibrin (PRF)- mediated sticky bone using a cortical allograft (Keystone Dental Group) (Fig. 17). Anattempt to attach the original PFMcrown to a temporary cylinder was unsuccessful, so a chairsidefabricated temporary crown (Fig. 18) was made and inserted (Figs. 19 & 20) with a small piece of PRF membrane. A radiograph veri ed the implant position and full seating of the provisional (Fig. 21). A follow-up assessment at 2 weeks (Figs. 22 & 24) demonstrated quick and uneventful healing, with very minimal reported pain. At 3 months (Figs. 23, 25, 27 & 28), there was excellent tissue color, tone and contour,

Figure 13. Pilot Drill, Frontal

Figure 14. Pilot Drill, PA

Figure 12. Pilot Drill, Occlusal

Figure 16. Implant Position

Figure 17. Jump Gap Bone Graft

Figure 15. Implant Placed with Guide

Figure 18. Provisional

Figure 20. End of Surgery, Frontal

Figure 19. End of Surgery, Occlusal

Figure 23. 3 month Follow Up, Occlusal

Figure 21. Final PA

Figure 22. 2 week Follow Up, Occlusal

Figure 24. 2 week Follow Up Frontal

Figure 25. 3 month Follow Up Frontal

Figure 26. 3 month Follow Up PA

72 AUSTRALASIAN DENTIST