Dental Tribune U.S.Edition No.3, 2016

Dental Tribune U.S. Edition | March 2016 A6 Ad March 17 – 19, 2016 Georgia World Congress Center & Omni Hotel at CNN Center Dr. James A. Roos, General Chairman & Dr. Jonathan S. Dubin, President • Earn up to 21 hours of CE • Join us for Hinman’s Night Out: Dancing in the Georgia Dome, an all-new Friday night experience featuring music, food, drinks and prizes. • Register before February 18, 2016 to take advantage of discounted pre-registration fees. To book a hotel or register online, please visit www.hinman.org. Fig. 8: Healed #12. Buccal view of keratin- ized gingiva, crown and solid implant. Fig. 8 Figs. 9a, b: X-ray pretreatment of #12 root canal/post/crown showing chronic bone loss (a). Bone regeneration (b). Fig. 9a Fig. 9b Figs. 9c, d: X-ray of implant with healing platform- switching abutment (c); nine years post-op with permanent abutment and crown (d). Fig. 9c Fig. 9d Fig. 10: Final buccal clinical view of #12 implant area. Fig. 10 DR. David L. Hoexter is director of the International Academy for Dental Facial Esthetics and a clinical professor in periodontics and implantology at Temple University, Philadelphia. He is a dip- lomate in the International Congress of Oral Implantologists, the American Society of Osseointe- gration and the American Board of Aesthetic Dentistry. He lectures throughout the world and has published nationally and internationally. He has been awarded 12 fellowships, including FACD, FICD and Pierre Fauchard. He maintains a practice in New York City limited to periodontics, implantol- ogy and esthetic surgery. You can contact him at (212) 355-0004 or drdavidlh@gmail.com. “ ESTHETICS, page A4 eration of the area supporting the implant (the sine qua non of success) and enhances keratinized gingival regeneration. Endosseous implants with a narrower abutment neck at the implant occlusal level can pro- vide a pathway to improved esthet- ics, predictable maintenance and longevity. Case presentation For more than 20 years, Mr. B. was repeatedly made aware of his ad- vancing periodontal disease. At every dental appointment (at least four times a year), he was shown his periodontal pockets and presented with treatment plans to arrest pro- gression. But he refused any treat- ment beyond maintenance through hygienic techniques. His reasons were primarily financial and, to a lesser extent, based on his age and status as a self-supporting, life-long bachelor. He presented on an emergency appointment at my practice with a large swelling on his upper left bi- cuspid #12 buccal area (Fig. 1). The #12 was mobile and elicited pain on touch. Years previous to com- mencing as my patient, Mr. B. had a root canal with post and crown on #12. The crown and post came out in total, leaving only the root. A fracture was seen on the occlusal aspect of the root (Fig. 2). After all options were presented, extraction of the #12 remaining root was rec- ommended. Local anesthetic was administered (HuFriedy Hoexter Mesio-Distal Luxators), and the root was extracted. The root was removed in an m/d movement. A cyst at the apex (Fig. 3) was seen and was removed in total using the same movement. Buccal and lin- gual osseous walls were preserved. A bone graft was placed in the voided socket, and a GTR resorbable membrane (Transgraft) was used (Fig. 4). After months of uneventful healing, the area was re-entered surgically, exposing a regenerated osseous ridge (Fig. 5). An ankylose implant with a design compatible with platform switching was in- serted. I placed a healing abutment at the time of implant insertion, as is my standard practice. Suturing was followed with an X-ray (Fig 9b). The patient was given antibiotic and analgesic prescriptions and post-operative instructions. Healing was uneventful and comfortable. Mr. B. resumed good oral hygiene in the area as soon as he was comfortable doing so. After several months, integration was achieved. The patient returned to the referring dentist to complete final prosthetic components. An ” ESTHETICS, page A8 CLINICAL

Dental Tribune U.S.Edition No.3, 2016

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