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ePaper created 2017-12-06, 11:14:19 | version 1.38.0
case report | Fig. 3: Condition after extraction. The inflammatory processes on the buccal side are clearly visible. Fig. 4: Separated root and inflamma- tory process in medium third. Fig. 5a: Single-tooth radiograph after replantation of dental crown. Fig. 5b: Condition after replantation of dental crown (intraoral). Splinting with SDR® (Dentsply Sirona) to adjacent tooth. implants 3 2017 13 Fig. 3 Fig. 4 Fig. 5a Fig. 5b Case history and treatment A 44-year-old patient visited our practice due to problems with tooth 23 for the first time in January 2016. The patient was healthy at the time of the con- sultation and suffered neither from acute nor chronic general diseases. The labial surface in the medium third of the root of tooth 23 was very sensitive to percussion. A dental X-ray scan of region 21–24 did not show any signs of resorptive processes (Fig. 1). The therapeutic goal was to restore the proper function of tooth 23 and to re- mediate the inflammatory processes. We suggested various therapeutic options and chose the implanto- logical treatment. Extraction and replantation Treating the alveolar bone and the surrounding tis- sue with care during the extraction may positively in- fluence the formation of defects.11 After cutting all periodontal fibres to be reached from the intrasulcu- lar side using a micro scalpel blade, the tooth was re- moved from the alveolar bone axially using forceps. Figure 2 shows the situation before and figure 3 right after the extraction. The resorptive processes in the labial area are barely perceptible in figure 3, are con- firmed though in figure 4, which shows the separated root and the internal resorption of the labial region. Crown and root were separated 2 mm below the enamel cement junction. If there was no root canal filling available, the dental pulp areas were to be cleaned and filled with composite filler. For replanta- tion, a pre-manufactured palatinal silicone key was used to attach the crown to adjacent tooth 22 by means of acid etching (phosphoric acid, Adhese® Universal, Ivoclar Vivadent) and composite filler (SDR®, Dentsply Sirona). Figures 5a and b show the situation right after replantation and fixing. Extrusion After ten days, a loss of approximately 1 mm of marginal gingiva in apical direction became evident (Fig. 6). We intended to recapture that by means of extrusion. The replanted crown was separated in the upper third (Fig. 7) after a healing time of ten days and extruded by 1 mm using rubber bands for 24 hours (Fig. 8). You can see the reactive tissue in the marginal area very nicely. The soft tissue is the first to follow the traction, then the bone. The stabilisation phase until the implantation was 16 weeks. Implant planning and implant procedure The aesthetic result depends on the three-dimen- sional positioning of the implant. After replantation and extrusion, volume loss was prevented and com- plete ossification of the alveolar extraction site was achieved. Figures 9 and 10 show the radiographical findings right before the implantation. In particular, the volume in orovestibular direction (Fig. 9, centre) prevents that the implant is positioned too far into the