RCT Prior to Implant? M

A 52-year-old man (smoker 1 ppd) has toothache in UR.  The tooth #4 has severe Class V defect (Fig.1 *), periapical radio-lucency (PARL, arrowheads) around the buccal roots and mild percussion.  PARL is more severe around the palatal root (Fig.2 P).  Since it seems difficult to do socket preservation, can we do RCT to regrow bone before implant?  CT coronal section shows the palatal defect of the palatal root (Fig.3,4), while sagittal one shows J defect of the palatal root, associated with root fracture (Fig.5).  In fact the palatal root has transverse fracture at crestal level (Fig.6-8).  The tooth #4 will be extracted for immediate implant (Fig.9,10); a 4 mm implant will be placed in the narrow space of #3 at the same time (Fig.11).  The patient had symptoms consistent with aortic aneurysm.  Since then smoke has been quit.

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Xin Wei, DDS, PhD, MS 1st edition 02/23/2020, last revision 04/04/2021