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Jonnathan posted an update
Hello gang!
I have this case that I am preparing for. It will happen in February. I don’t have a CT on this Patient. It is a tooth that has had a RCT. I can see a PAR on tooth and caries that Fractured the crown. Tooth will come out and I am preparing for both scenarios: either extraction and socket preservation, or extraction and immediate implant.
Any advise you guys may give would be much appreciated.
I prepared an essix appliance with tooth colored paint on the plastic.
Jedediah, Cayleen and 2 others5 Comments-
Hey Jonathan! Several different ways to attack this. If you’re thinking of potentially doing an immediate implant, I would definitely have a CBCT. If you do a lot of immediate implants, and there is sufficient bone, typically, I do these flapless
If you haven’t done any immediate implants. Typically it’s nicer to start with pre-molars as they can be more straightforward and less aesthetic areas if the case is not ideal. More Straightforward would definitely be extract graft and come back and place a healed implant.
If you do want to place an immediate implant, but haven’t placed a lot of them then I would definitely lay a flap a full thickness flap so that you can better visualize the bone and contours on the buccal and the Palatal side. It typically is much easier to place well when you have better vision. Either way, I would get a CBCT first.
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Hey great question!
Another thing to consider is tissue biotype. I think I have some decent implant skills, but I still refer out thin biotype cases in the anterior region to Perio. It’s just a personal preference. What do you do for those cases @restoredsmiles
Do you know the biotype for this patient Jonathan?
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Great point Ivan. If it is a healed site and a thin biotype, I may take even make more of a palatal line angle incision to move more keratinized tissue over to the facial aspect if it’s a maxillary implant. Also, I typically would place my implant, deeper or more apically to help improve the thickness of that tissue if it is thin biotype, which can also help improve that area and give it a better long-term prognosis. Implant depth is especially important on those thin, biotype cases
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Thick Biotype.
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Thick biotype is easier to work with than thin. Unless I get a spinner or there are risk factors such as smoking and diabetes, I place bone graft and a healing abutment on right away.
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