From: Dmitri Ruzanov
To: ankylos@rxdentistry.com
Sent: Thursday, June 17, 2010 5:21 PM
Subject: Hot off the press

Just finished this...
Not the best immediate aesthetic outcome, however i guess it will work out long term...

d11 had a terminal restauration of cast post and core and a crown. Now all this suddenly came out because of
root infracture. Her dentist deemed the tooth non-retreatable and sent her over to me for implant replacement.

Atraumatically removed the root with scalpel blade and a mallet...
Palatal wall osteotomy... hence the funky angulation of the implant (and i am not happy with this, though
Ankylos would forgive such mistake on a good day :-) )

Placed implant, took an index transfer to fabricate indirect provisional...  Sulcus Former, BioOss to close
palatal gap and collagen on top of it. Fitted "flipper" to not touch the area...

It was my first immediate placement in upper central site... i planned actually for implant retained
non-functional provisional, but i chickened out (plus, i had a flipper done ex-tempora, so i didn't really
have to push myself too much) What say you? - Dmitri


















GREAT CASE DMITRI, I AM SURE THE FINAL RESULT WILL BE FANTASTIC - JOSE

Dimitri:, Is the placement as far facial as it appears.  Generally, one wants to be along the lingual wall of the socket
in an immediate placement.  Really makes things much more difficult if too far facial in developing facial profile and
having adequate porcelain thickness.    - gary

Gary, the implant itself got stabilized in the palatal wall... just had to do at this less-than-OK angle because
of the socket topography, shaking hands a lack of experience with these cases. Any input and advice is greatly appreciated!

My take is that if i have to back up from the apex ca 2mm and start drilling the palatal wall, then is natural i will be
at an angle. If then i decide to straighten up a bit, then i just jag all the bone separating apical part of the socket
(and that is close to buccal wall i want to keep clear of) from the palatal osteotomy. Maybe i miss something...

I know, restoratively it is a PITA to get decent aesthetics. But i hope for submergence possible on Ankylos and i would
develop deep emergence profile... might be a soft tisuue grafting case - if stars are really in a bad allignment...

- Dmitri

Dmitri, another hint when placing implants in the anterior area and being face with that situation is to place the implant
a little bit deeper, that way the coronal part of the implant will be more palatally in relation to the adjacent teeth,
you will only need a taller abutment. Hope this helps . - Jose