The patient presented with the chief complaint of pain in tooth number 14, which had previously been endodontically treated. The most likely differential diagnosis was a vertical root fracture. The patient was offered several restorative options, and chose to have the tooth extracted and an implant placed. A regimen of antibiotics was prescribed for three days prior to the extraction to reduce the risk of infection to the socket, which could impair implant and/or graft integration.
Tooth #14 was extracted atraumatically and the socket curetted to remove infected tissue. Since primary stability of the initial implant placement is critical to the success of integration, and upper molar rootforms are not ideally located for implant orientation, it was decided to augment the site and allow it to heal before placing the implant. BaseBone cortical allograft was chosen due to its osteogenic properties and superior handling. The extraction socket was sutured with a double-figure-eight, and the patient was appointed for recall in three months to determine healing.
After three months, the graft was fully integrated and the site exhibited dense bone. An osteotomy was initiated with a flapless procedure starting with an osteo bur followed by a 2.0mm pilot drill to achieve the proper depth, then finished with a 3.7 Multi-Drill. A 5.0 x 11.5mm OsteoConverter® Performance implant was threaded into the osteotomy site with a hand carrier and then driven to osseous level with the OsteoDriver™. The implant was allowed four months to integrate with a standard healing cap.
After the implant had integrated, a 7mm OsteoReady customizable anti-rotational abutment was placed followed by a crown impression, and an e.max® crown was fabricated. The crown was cemented and adjusted for occlusion. The patient was extremely satisfied with this simple, four-visit procedure replacing a fractured molar with an implant-supported crown. The combination of BaseBone with OsteoReady implants provided a straightforward and esthetic result for this patient.
Dr. Guy Gross is a highly credentialed faculty member at OsteoReady, having earned his dental degree with honors from the University of Missouri-Kansas City School of Dentistry. He is an active Master of the International Congress of Oral Implantology. With his endless passion for Continuing Education, Dr. Gross brings an enormous body of knowledge to OsteoReady and likewise to the field of implantology.