Severe Gingival Recession

A 74-year-old man requests the 5th implant placement at #30.  He feels that immediate implant (1,2) is associated with less pain than delayed one.  He is looking forward the immediate implant at #30.  This tooth has severe gingival recession (Fig.1,2): the mesial (M), distobuccal (DB) and distolingual (DL) roots having been exposed.  The socket with the tripod septum will be treated with Metronidazole, randomly selected by case sequence.  One of challenges to implant placement is to handle keratinized (K) and non-keratinized (N) gingival tissues.  After tooth removal and infection resolution, it is expected that some of non-keratinized tissue can be converted to the keratinized one to promote health of the implant.  Fabricate a tightly fit immediate provisional to cover the irregularly-shaped socket.  Use a nonresorbable membrane where the provisional is unable to cover the socket.  Preop PA is to be taken for design.  Bone height should be limited.

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Xin Wei, DDS, PhD, MS 1st edition 08/11/2015, last revision 08/21/2015