26/08/2023
I completed this case recently, which was a tragic Friday night incident affecting both maxillary central incisors. The tooth 11 had an extrusive luxation and horizontal fracture, and tooth 21 had crown-root oblique fracture palatally.
The referring dentist extirpated the exposed pulp and placed some flexible splint, which eventually stabilised the tooth but the fairly significant horizontal fracture worried the patient regarding the prognosis of further treatment. The tooth 21 was also in a tricky situation as the oblique fracture margin was at the crestal level, which meant any adhesive procedure or indirect work would have a guarded prognosis.
The patient decided to replace her central incisors with dental implants.
This case is interesting in a sense that two centrals received immediate implants but were done with different techniques. Implant on 11 site had a conventional jump gap grafted with a biomaterial (in this case, cancellous allograft from Puros) with CTG from the palate as it had an intact buccal wall. Implant on 21 site had a socket shield. I have been doing socket shield for around 5 years now and it works really well for me.
The outcome is interesting and considering that this is from a single surgery, I love the outcome. I expect the 21 implant to be stable as the mother nature is fooled by the socket shield. The 11 implant, I believe, will also be very stable, as we have both thick bone and tissue. The CBCT shows more than 3mm of buccal bone which according to the literature, provide a long term tissue stability.
I used the Inverta coaxis implant from Southern. This implant has interesting macro-geometry features, it is designed for immediacy and Prof. Howes’ work on Coaxis is a really smart way to get a cingulum screw access without using a biaxial screw. Southern Implants Southern Implants Australia/NZ
The technical work was done by Brandon Lee, he did a fantastic job despite the difficulty with significant maxillary cant.
I hope you enjoy this case, and as always, any comments or feedback are welcome!
