Regenerate Bone For Neighboring Tooth (M)

Because of delay in treatment for 6 years, the tooth #9 extrudes (Fig.1 arrow) and has abnormal contact with an opposing tooth (Fig.2 ^).  There is bone loss on the mesial surface of the tooth #10 (Fig.3 <; 5 *).  In addition to scaling, Endogain is applied to facilitate re-attachment and bone growth.  To compensate for severe bony defect, a long implant is planned (Fig.4, 3.8x18 mm) and executed (Fig.6,7).  Allograft and Osteogen mixture is placed in the gap and along the mesial surface of the neighboring tooth (Fig.7 <).  The crown of the extracted tooth is modified and relined as an immediate provisional (Fig.8,9 P) without interference.  The displaced buccal papilla between #9 and 10 (Fig.8 *) is kept in place with periodontal dressing (Fig.10,11).

Six weeks postop, the patient returns for provisional reline.  The labial gingival cleft and the distal black triangle (Fig.12 white and black arrowheads) have not resolved.  It appears that bone graft is partially dislodged distally (Fig.13) with re-exposure of the root surface of the tooth #10 (Fig.14 *).  The distal buccal and palatal papillae should have been sutured.

The patient returns for final restoration 3 months postop (Fig.15-19).  The density of the bone graft decreases (Fig.15, as compared to Fig.7).  The margin of the provisional should have been trimmed more rounded (Fig.16 dashed line).  The buccal atrophy remains minimal (Fig.17).  The distal papillary separation has not become worse (Fig.18,19).  Two weeks the crown is seated as a modified screw type after removal of residual cement.  The minor abutment exposure should disappear over time (Fig.20 ^).  The papillary regression (including palatally, Fig.21) may recover to a less degree.  As expected, there is no buccal abutment exposure 3 years 1 month post cementation (Fig.23), while the palatal papilla seems to reform between #9 and 10 three years 1 month post cementation (Fig.24). 

Return to Upper Incisor Immediate Implant Similar Case

Xin Wei, DDS, PhD, MS 1st edition 06/29/2016, last revision 12/22/2019