implants - international magazine of oral implantology

I case report _Introduction Endodontic and periodontal problems, such as sur- gicalcomplications,oftenplacebeforetheprofessional the dilemma of choosing between tooth preservation and extraction. Correctly performed root planing usu- allyleadstosoft-tissuerecession.Incasesoftoothmo- bility, periodontal surgery can improve the situation onlyintheshortterm.Toothlosseventuallyfollowsaf- tersomemonthsoryears,nottomentiontheaesthetic disadvantages of flap elevation and tissue excision af- ter periodontal surgical treatment. Similar outcomes arepredictedforteethfollowingendodontictreatment, particularly if they show complications or have under- gone root resection. The combination of endodontic and periodontal problems, as with periodontal-en- dodontic lesions, endangers the tooth, as well as the boneandtheanatomyofthejaw.Lesionssuchasthese canresultinseveredefects,hamperinganysubsequent treatmentwithprostheses.1 The question one ought to be asking is whether a tooth in the aesthetic zone should be treated until all treatmentoptionshavebeenexhaustedorwhetherthe extractionofthistoothattherighttimecouldincrease thesuccessandaestheticoutcomeoftheimplanttreat- ment.Theextractionofatoothintheaestheticzoneim- mediatelysolvestheinflammationproblem,butthedif- ficultiesonlybeginatthispoint.Therearemanyaspects to take care of in order to achieve aesthetic success. Analysis of hard and soft tissue, the implant system, timeofimplantation,flapdesignandclosureofthearea, implantposition,implantdimensions,temporarytreat- ment and prostheses are all factors that influence the treatmentoutcomemassively. _Case history A 34-year-old female patient visited our practice twoyearsago,withcomplaintsabouthermaxillarycen- tralincisor(tooth#21).Thetoothhadbeentreateden- dodontically eight years before. Five years later, the tooth had been retreated owing to complaints and she had undergone root resection a year later. Afterwards, anintra-radicularpostandametalceramiccrownhad beenplaced. At the time of the patient’s first visit, the tooth was mobile, bled from the periodontal gap during brushing and caused pain, resulting in headaches. Considering the extended period for which the patient had been strugglingwiththistooth,aquickandeffectivedecision hadtobemade. _Findings There were no general pathological findings. Clini- cally,wefoundaGradeImobilityintooth#21,amobile crownontooth#21,andableedingonprobingscoreof 3.Thesulcusprobingdepthwas2to3mm.Thevertical percussion test was negative at this point (Fig. 1). The restoftheteethexhibitednopathologicalfindings. Immediate implantation in the anterior maxilla Planning in reverse Authors_Dr Nikolaos Papagiannoulis, Dr Olaf Daum, Dr Eduard Sandberg & Dr Marius Steigmann, Germany 24 I implants3_2012 Fig. 1a Fig. 1b Fig. 1c Fig. 2a Fig. 2b