immediate implant #6
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From: "Arturo R. García D.M.D."
Sent: Monday, October 06, 2008 4:06 AM
Subject: [roots] Ext and immediate implant #6
This patient has some home care and diet issues, is diabetic and has
ignored his mouth for many years. I can see that he as UAO and think he
has OSA and is regurgitating at night so I have advised to get a sleep
study. Hopefully that will control his SA and his stomach acid and help
him keep his teeth. He has decay everywhere and none of it is small.
Lots of cervical and root decay as you can see from the pics and xrays.
He's a big guy, ~ 6'2" and he had a big canine. I extracted it slowly
(compared to a standard forceps ext) and carefully with a periotome. I
checked the socket carefully under hign magnification and the buccal plate
was intact. I placed a 4.5 x 14 mm Ankylos implant by hand. Obviously I
did not need to use an ostetomy bur :-). I was worried that I would not
be able to get primary stabilization because of the size of the socket,
but I did. I placed a DFDB graft w CaSO4 and closed with a long term
membrane and vicryl suture. I'm sure I will get some more hard and soft
tissue collapse as the area heals. The pics are from an intra oral camera
and not the best, but its the best I had available. I have pre ops and 2
week post op pics. #7 needed a rct,p/c and crown. For the rct #7 I used
Ghassan's F2 protaper instrumentation technique and obturated with
Resilon/Epiphany Obtura 2 all squirt technique. I was lucky to be able to
use the temp crown from #7 to make a fixed temp bridge to provide a stable
temp. With the healing the pontic is becoming hygienic.
Would you have opted in a situation like this to graft #6 and them come
back in 4-6 months and place the fixture then? Also, in a similar case
would you feel comfortable placing an immediate implant like this working
off of a peri apical xray alone? peri apical and pano xrays alone? I
treated this case in the way I feel comfortable doing and also in away I
feel will be successful. I'm just curious if you would consider it
overkill to routinely get a CT for an immediate case like this? Or do you
think I was overly agressive?
Arturo R. García D.M.D.