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Funky angulation of implant - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
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 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

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant

Funky angulation of implant 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

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