Funky angulation of implant - Courtesy ROOTS
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From: Dmitri Ruzanov
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 restoration 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
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