PMC8248266_01
(a) The patient was missing the left maxillary posterior teeth, while the cuspid was deemed to be nonrestorable. (b) After the cuspid implant placement, a large semilunar gap remained. (c) No grafting was done and the soft tissues loosely sutured around the canine healing abutment. (d) This radiograph was taken at the 1 year follow-up and shows excellent bone healing. (e) A clinical photo corresponding to the radiograph in Figure 3d.
DRJ-18-29-g003.jpg
PMC8248266_01_DRJ-18-29-g003.jpg
F3
Clinical and radiographic examinations revealed the maxillary left cuspid to be un-restorable [Figure 3a]. The tooth was atraumatically extracted using flap-less surgery and a 4 mm diameter by 12 mm long-implant placed immediately with positioning toward the disto-palatal leaving a large semilunar gap affecting the buccal, mesial, and palatal aspects [Figure 3b]. No bone graft or barrier membrane was used, and the flap margins passively sutured with 3-0 silk sutures [Figure 3c]. At 12 months, a periapical radiograph showed excellent bone healing [Figure 3d], and a clinical photograph confirmed favorable tissue contours [Figure 3e].
(a) The maxillary right first molar suffered endodontic treatment failure and developed a large periapical lesion that had lifted the sinus floor via periosteal reaction. The inter-septal bone had been left intact coronally. (b) The inter-septal bone was sufficient to stabilize the implant but there remained both buccal and palatal bone dehiscence and large gaps. No grafting was done and the site allowed to heal by secondary intention. (c) A radiograph taken at 2 months showed new bone forming in the nongrafted socket. (d) This photo taken 3 months after implant placement showed excellent soft-tissue healing with minimal alveolar ridge remodeling. (e) The clinical situation 1 year after implant restoration showing excellent buccal tissue contours.
DRJ-18-29-g004.jpg
PMC8248266_01_DRJ-18-29-g004.jpg
F4
An example of a Type IV defect is shown in Figure 4. The pathology had been present long enough to put pressure on the sinus floor and cause a periosteal bone reaction [Figure 4a]. Using a flap-less approach, the tooth was removed atraumatically revealing intact inter-septal/furcal bone [Figure 4b]. A radiograph taken at 2 months [Figure 4c] showed the root sockets to be healing well. A healing abutment was placed at 3 months after which excellent soft-tissue healing occurred [Figure 4d]. The clinical situation after restoration at the 1-year recall visit showing excellent buccal contours is shown in Figure 4e.
(a) After atraumatic extractions, the clinician opted to place the molar implant in the palatal root socket leaving the two buccal roots un-grafted. (b) Minor flap manipulation was done to rest on and covers the undisturbed inter-septal bone. (c) The immediate postop radiograph shows the large defects left behind by not grafting the two buccal root sockets. (d) Excellent soft tissue healing was documented at 3 months. (e) A radiograph taken after 4 months healing.
DRJ-18-29-g005.jpg
PMC8248266_01_DRJ-18-29-g005.jpg
F5
An implant of 4.8 mm diameter and 12 mm length was placed into the palatal root socket of the first molar leaving both buccal root sockets un-grafted [Figure 5a]. Healing abutments including one of large diameter for the molar implant were placed, and the soft tissues passively stabilized with sutures [Figure 5b]. A periapical radiograph taken immediately after implant placement demonstrated large gaps left as a result of not grafting the buccal root sockets [Figure 5c]. At 3 months postop, the marginal soft tissues showed a wide band of keratinized tissue [Figure 5d]. A periapical radiograph taken at 4 months demonstrated the gaps to have filled with new bone [Figure 5e].
(a) This mandibular right first molar was condemned as nonrestorable. (b) The axial slices of the cone-beam computed tomography scan suggested there to be adequate inter-septal bone to stabilize an IMI. (c) Once the implant had been placed, large gaps remained both mesially and distally. Surgery performed by Dr. Quang Nguyen, Periodontics Resident, Faculty of Dentistry, University of Toronto. (d) The immediate postoperatve radiograph confirms good implant positioning and use of a large diameter healing abutment. (e) A radiograph taken at 4 months revealing excellent bone healing.
DRJ-18-29-g006.jpg
PMC8248266_01_DRJ-18-29-g006.jpg
F6
A nonrestorable mandibular first molar tooth [Figure 6a] was planned for extraction, and a preparative CBCT scan suggested that the tooth had sufficient inter-septal bone to stabilize an IMI [Figure 6b]. The distance from the mesial and distal surfaces of the implant to their respective socket walls was 4-5 mm [Figure 6c]. A radiograph taken immediately after implant placement showed socket gaps both mesially and distally [Figure 6d]. A radiograph taken at 3 months demonstrated the mesial and distal gaps filled with new bone [Figure 6e].
(a) A hopeless mandibular first molar required extraction and the patient wished to have it replaced with an IMI. (b) Following atraumatic extraction and implant placement into the inter-septal bone, a large gap remained distally. Surgery performed by Dr. Armin Khosravi, Periodontics Resident, Faculty of Dentistry, Islamic Azad University, Isfahan Branch, Iran. (c) The gap was left un-grafted and the soft tissues loosely repositioned with two sutures. (d) The healing happening by secondary intention at 10 days postop. (e) Soft-tissue healing of the site at 2.5 months. (f) The radiographic appearance at 2.5 months showing excellent bone fill of the large distal gap.
DRJ-18-29-g007.jpg
PMC8248266_01_DRJ-18-29-g007.jpg
F7
The two roots of a hopeless mandibular left first molar [Figure 7a] were atraumatically extracted following sectioning of the tooth through its furcation. The final position of implant was slightly more mesial than ideal leaving a large gap distally [buccolingual >9 mm and mesiodistal >7 mm; Figure 7b] which was left un-grafted following placement of a large diameter healing abutment [Figure 7c]. By 10 days, the gap was seen to be healing by secondary intention [Figure 7d]. A clinical photograph [Figure 7e] and periapical radiograph [Figure 7f] taken at 2.5 months demonstrate good soft-tissue healing and crestal bone levels up to the implant platform.