PMC9507756_01
Palatal (a) and facial (b) views of M-D radiographic sections and facial plate thicknesses (c and d).
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fig1
The crown was mobile and a small manual force was enough to dislodge the postcrown leaving a root with no ferrule effect, hence designated as hopeless (Figures 1(a), 1(b), 1(c), and 1(d)).
Lateral view upon smiling (a), occlusal view of extraction site of tooth 25 after 8 weeks (b), B-P radiographic section with root fragment in situ (c), and occlusal and buccal views of the healing abutment and remaining root shield immediately following implant placement (d and e).
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fig2
Upon esthetic risk assessment, it was evident that the patient had a high lip line with a thin phenotype (Figure 2(a)), aggravated by the patient's high esthetic demands. After 8 weeks (Figure 2(b)), another CBCT was taken to check the root fragment and the socket healing (Figure 2(c)). After that, a O 4.7 mm bottle-shaped gingival former was attached and no interim prosthesis was provided based on the patient's preference (Figures 2(d) and 2(e)).
Zirconia crown cemented onto titanium abutment (a) and (b), lateral and occlusal views of crown screwed into the implant (c) and (d), postoperative PA (e), F-L radiographic sections (f), F-L section verifying width of hard facial tissues (g), and F-L section verifying width of facial plate crest (h).
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fig3
After the laboratory work was finalized and checked on the dental cast, the definitive veneered-zirconia crown was cemented onto the abutment using dual-cured resin cement (TotalCem, ITENA, France) (Figures 3(a) and 3(b)), and then the abutment-crown assembly was transferred to the patient's mouth, tried-in and screwed into the implant using an insertion torque of 35 Ncm. After 16 months of loading, the PES and WES were collectively about18 of 20, indicative of an acceptable esthetic outcome with very minimal volumetric ridge changes, confirming the patient's satisfaction (Figures 3(c) and 3(d)). A significant bone fill between the root fragment and the implant was verified (Figures 3(e), 3(f), 3(g), and 3(h)).