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implants UK - the journal of oral implantology

40 I I clinical _ sentimental tooth implants1_2011 Myadvicewastoextractthistoothandtoreplace the missing teeth on that side with a Nobel Replace implant retained bridge (Fig. 3). An added benefit wouldbethereliefofherchronicfacialpain.Shetook myadvice,thetreatmentwasdulycarriedoutandthe facialpainceased.Fouryearslatersheisstillsymptom freeandnolongertakesanyTegretolorAmitriptyline. _Case 2 This lady presented us with a problem of function in that she only had three functional upper anterior teethleftthatwereactingashermainchewingteeth. Furthermore she had numerous retained roots and a root filled UL7. Whilst it is clear that the upper arch was notinthebeststateoforalhealth,theissueIwouldlike to focus on here is that of retained roots. Sometimes when we extract teeth the crown fractures and we are left with the root retained in the bone. In this situation we may make the decision not tofurtherextracttherootduetothepotentialdifficul- ties this course of treatment may involve. The second reasontoleavetheretainedrootin-situistomaintain the bone anatomy in the area. Both are reasonable reasons to have retained roots. Inthefirstinstance,ifweforegorootextractionto avoid procedural complications, at the very least we should monitor the retained root with annual radio- graphs to ensure that the bone around the root is in- tact and healthy. This should also reveal a continuous laminaduraaroundtheretainedroot(s). Iftheclinican fails do this, they will have no idea what damage may be occurring due to chronic infection caused by the retained roots. With regard to the second mode of thought (to keep retained roots in order to maintain the bone anatomy) we now have perfectly good bone substi- tutes to place into sockets where a tooth has been extracted, such as Bio-Oss collagen by Geistlich. The OPG for this patient (Fig. 4) clearly shows that the UR4 retained root is affecting the bone around it with a large radiolucency (Fig. 5), which is indicative of a chronic infection around the root. The surgical picture indicates the size of the defect produced as a result of the chronic infection (Fig. 6); this presents a realproblemwhenplacingimplantsinordertoreturn this patient back to normal function. Ultimately, we did find healthy bone to place the Nobel Replace tapered implant, which was used to retain an upper implant -retained denture. Thisisanotherexamplethatdemonstrateshowwe need to make judgements early on or take the neces- sary action to ensure bone loss does not occur at a laterdatewhichcancausedifficultiesinrestoringthe patient to full dental form and function. _Case 3 This was a patient referred to us to restore the upper anterior region with an implant re- tained bridge after loss of the previous bridge from Fig. 3 Fig. 3_: Implant retained bridge Fig. 4_: OPG Fig. 5_: Close up retained root Fig. 6_: Bony defect Fig. 4 Fig. 5 Fig. 6