PMC5902076_01
The remaining roots in teeth 1.4 and 1.5 presented decay and exposed endodontic treatment. Tooth 1.6 had an extensive crown restoration and deep, subgingival distal decay.
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The dental team performed a clinical examination (Figure 1) and a radiographic study (Figures 2(a) and 2(b)) on the patient detecting decayed remaining roots in teeth 1.4 and 1.5 and performed an extensive restoration presenting deep, subgingival distal decay on tooth 1.6.
(a) Preoperative radiograph. (b) Upper maxillary CBCT of Tooth 1.6.
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The dental team performed a clinical examination (Figure 1) and a radiographic study (Figures 2(a) and 2(b)) on the patient detecting decayed remaining roots in teeth 1.4 and 1.5 and performed an extensive restoration presenting deep, subgingival distal decay on tooth 1.6.
Implant paralleling pin inserted after interradicular bone drilling.
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Once the roots were clinically visible, the drilling sequence recommended by the implant manufacturer was performed through the tooth, always corroborating the drilling direction with a paralleling pin (Figure 3).
Remaining root aspects were carefully extracted using desmotomes.
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When the drilling sequence was completed, the remaining root fragments were carefully removed using desmotomes (Figure 4).
Immediate implant placement of an Alpha Bio ICE 5.3 x 10 mm implant in fresh extraction socket.
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Tarnow classification (Figure 5). To promote a nonsubmerged healing approach, a standard healing abutment of 4.6 mm of diameter and 4 mm of length (Alpha Bio, Alpha Bio Tec.) was connected to the implant. The 3 mm horizontal gap between the implant and the bone walls was filled with a xenograft (Alpha Bio's Graft, Alpha Bio Tec.) Finally, platelet-rich fibrin (PRF) membranes were fixed through a monofilament nylon blue suture No. 5/0 (Tagum 2/0 HR25, Tagumedica S.A.). Additionally, Alpha Bio ICE 3.7 N x 10 mm implants were placed in teeth 1.4 and 1.5 (Alpha Bio Tec.) (Figure 5).
Closure using a 5.0 nylon suture.
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At this time, the gingival architecture remained stable with preservation of a functionally attached gingiva (Figure 6). At 6 months and 12 months follow-ups, clinical and radiological exams showed that the bone levels remained stable (Figures 7 and 8).
Follow-up at 6 months.
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At this time, the gingival architecture remained stable with preservation of a functionally attached gingiva (Figure 6). At 6 months and 12 months follow-ups, clinical and radiological exams showed that the bone levels remained stable (Figures 7 and 8).
Prosthetic delivery radiograph.
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At this time, the gingival architecture remained stable with preservation of a functionally attached gingiva (Figure 6). At 6 months and 12 months follow-ups, clinical and radiological exams showed that the bone levels remained stable (Figures 7 and 8).
One-year follow-up.
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In addition, the prosthetic structure remained in optimal clinical condition, displaying optimal esthetic and functional results (Figure 9).