INTRODUCTION
I present this case report of sudden fracture of tooth 12. The aesthetic request of patient was high. The initial status was complicated from deep overbite, low bone density, unfavorable anatomy for the right prosthetic axis of implant to perform a screw-retained crown. I chose the PET approach (Partial Extraction Therapy) to maintain in the long time a good volume of buccal plate and the osseodensification to achieve the primary stability of a post-extraction implant with immediate loading. The quick soft-tissue adaptation and the prosthetic solution applied after one week has allowed functional and aesthetic results well accepted from the patient.
Woman 78 years old with deep overbite and facial displacement of tooth 12.
Lack of papilla between 12 and 11.
Fracture of fiber post
Removed palatal portion of the root
The apex must always be removed.
This is the “Socket Shied”. The vestibular root preserve the vascularization of periodontal ligament and bundle bone attached. So, as scientific evidence from 9 years (Hürzeler MB, 2010) and several others until 2019, there is not resorption of buccal bone that maintains also the soft-tissue stability.
Osseodensification with Densah burs to achieve primary stability of implant in very low bone density. The burs rotating in reverse not remove the bone, but compact it.
Resista Implant IC 3×15 mm
Palatal placement of implant with adequate space between the Socket Shield and the fixture. This gap, as new guidelines on PET at JTI 2017 of Madrid, must not be filled with biomaterial.
No fit due to interference of titanium component with the bone.
Modified the titanium component.
Good fit.
The metal stem prevents the flow composite to penetrate inside the titanium component.
After polymerization of flow composite inside the temporary screw-retained crown.
After finishing and polishing. Smooth neck of 3 mm.
Unsatisfactory aesthetic.
Umbrella Concept
After one week. I have to do something different…
Intra-oral vertical preparation to maintain the hemidesmosomes attachment to smooth neck of titanium component. For this reason it must not be unscrewed.
After accurate and atraumatic vertical preparation. No bleeding of soft-tissue.
Spontaneous hermetic closure and attachment favored from immediate temporary screw-retained crown.
Cemented crown with few amount of TempBond only on the occlusal part. No excess of cement in the sulcus.
The patient is very happy.
The smooth neck 3 mm height below the crown.
One-time abutment.
Lack of papilla between teeth 12 and 11 from beginning. Waiting the evolution in the time.
CONCLUSION
This case report is related to modify the prosthetic step of the classic Socket Shield technique (screw-retained temporary crown after immediate post-extraction implant) when an unfavorable anatomy of the alveolus prevents an optimal aesthetic and functional result with a screw-retained crown. It’s important to perform also an aesthetically ugly screwed crown to achieve soft-tissue attachment during the first week. After this time, it’s crucial avoid to remove the titanium component in order not to destroy the hemidesmosomal attachment. So we need to prepare the component, like a natural tooth, to achieve the right position of a cemented temporary crown.
REFERENCES
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