PMC7704198_01
Preoperative clinical and radiographic presentation of tooth #21. (a) Intraoral frontal view shows associated gingival recession and an uneven incisal plane. (b) Periapical radiograph shows extensive root resorption affecting the coronal third of the root.
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He had a high smile line, uneven anterior incisal plane, and a class I incisal relationship (Figure 1(a)). Radiographically, tooth #21 was root canal treated, had communicating root resorption affecting the coronal third of the root, and interproximal, labial, and palatal bone resorption (Figure 1(b)).
GI subgingival "Imam matrix" that sealed the resorptive root defect.
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Once the GI had set, the paper points were removed from the canal and an access cavity was prepared to leave a 1 mm subgingival band of GI isolating the canal space from the surrounding tissue (fiber post drill; 3M) (Figure 2).
Clinical and radiographic presentation after orthodontic extrusion of tooth 21. (a) Intraoral frontal view showing the coronal relocation of the gingival margin and preservation of interdental papillae. (b) Periapical radiograph showing the coronal repositioning of the apex of the tooth and bone fill proximally.
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Clinical and radiographic images suggested sufficient formation of bone and soft tissue (Figures 3(a) and 3(b)).
Extracted tooth 21 with well-adapted deep margins of the provisional restoration.
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After achieving satisfactory nonsurgical bone and soft tissue augmentation around tooth #21, the patient was referred back to his periodontist for atraumatic extraction of the tooth (Figure 4) and immediate implant placement (Keystone, Lifecore) and loading with a provisional crown (Figures 5(a) and 5(b)).
Clinical and radiographic presentation of the immediately placed implant with provisional restoration for tooth #21. (a) Intraoral frontal view. (b) Periapical radiograph.
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After achieving satisfactory nonsurgical bone and soft tissue augmentation around tooth #21, the patient was referred back to his periodontist for atraumatic extraction of the tooth (Figure 4) and immediate implant placement (Keystone, Lifecore) and loading with a provisional crown (Figures 5(a) and 5(b)).
Postoperative clinical presentation of the definitive implant-supported crown of tooth 21.
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Six months later, a definitive screw-retained zirconia crown was fabricated (dynamic abutment solution) (Figure 6).