Extraction and immediate implant placement. Ankylos with its apical thread pitch allows for great primary fixation and a great implant for immediate placement after extraction and loading (provisionalization). Atramatic extraction--full flaps (not always) to view possible concavities and aid in preventing perforation of the ossteotomy. Palatal wall used for initial drill sequence--always following path of draw (not to buccal or lingual) for ideal restoration (Renzo would say) think about the end and the beginning. Implant guide pin to illustrate your path of the implant. Implant placement.
Bone grafting buccal gap (autogenous plus allograft/xenograft) periodontal probe to aid in a pumping motion to direct the graft apical so no space or gap is present. Abutment selection (usually standard abutment) straight 1.5 x 6 std. or sometimes 1.5 x 6mm angled (depends on bone and sulcus depth), temporization, margination, occlusion (out of occlussion) (composite choice of material), suturing (vertical mattress 5.0 PS3 needle), my final temporary and off to the generalist to finalize my temporary. I do this a majority of the time with hopeless anteriors and some bi-cuspids. (one tooth, two teeth, sometimes five). Why do I do this so early is because of the 3 dimensional aspect of the interproximal tissue/bone you save, which means you do not have to re-build with countless grafting procedures, undue scaring. Also the literature points out this is as successful as any delayed approach. With anterior esthetics's so important--I think this is a good procedure to have in your repertoire. |
