Patient has an ankylosed root of tooth #9. Can I place an implant through the root? Or do I have to extract the root and do a conventional placement? Will a buccal bone graft needed? Buccal thickness is about 0.75-1.5 mm with 0.75 mm at end of implant. Thank you very much for your help.
timcarter comments:
Perhaps I am missing something but I do not see your problem here. This image is not so good but any ankylosed root that might be in that site will be obliterated by your osteotomy. If that little radiopacity in the coronal 1/3 is what you are concerned about I would suggest you just remove it conventionally and proceed on with an immediate implant and possible a graft at the time of placement.tony_n comments:
Dear Drs, I thought that by placing the implant through the root, I can save the buccal plate and not need to do bone grafting. Thanks!timcarter comments:
The problem is that you have no buccal plate, only a root fragment. By the time you drill your osteotomy through what is remaining you will likely have a brittle fragment of something on the buccal that will sequester in time so I would just remove it and proceed as normal. I have been doing this for over 20 years and have experience with both approaches so this is only my opinion based on my experience.tony_n comments:
Thanks! I'll do as advised.dffdds comments:
Uncharted waters. Generally if a dentin fragment is less than 1mm it may resorb. There is a risk for a failure. May be best to remove the fragment from the facial, graft (maybe split the ridge) and wait. Dennis Flanagan DDS MScgummum comments:
This looks like the socket shield technique described by Salama but more predictable. Seems likea good idea