RCT Prior to Implant? I

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, arrow-heads) around the buccal roots and mild percu-ssion.  PARL is more severe around the palatal root (Fig.2 P).  Since it seems difficult to do socket preser-vation, 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 10/04/2020