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| Smile Restoration by the Girldoc |
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| Root fracture #9 multiple horizontal and buccal plate fractures. |
My Toddler Head-Butt me
This 30-year-old mother called the office at 8:30 AM stating that her ...”toddler head head butt me and one of my top upper incisors was extremely loose, I think it’s broken and it is going to have to be removed.”Patient presents with obvious horizontally fractured root of tooth #9. +3 mobility and a slight tear of the buccal mucosa over #9. Her dentist splinted her teeth temporarily but it was inadequately fixated and the buccal plate had been splintered and was not salvageable.
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| Guided Bone Regeneration. Radiopaque graft see #9 |
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| Guided Bone Regeneration. Radiopaque graft seen #98 |
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| Severe buccal plate deficiency on 3DCT, Cone Beam scan, implant work-up |
Root Fractures
Tooth #9 had several horizontal root fracture halfway down the route, with signs that the tooth had been luxated out of the socket. She recalls pushing the tooth back into the socket. She opted for extraction which was more predictable and performed atraumatically. The socket was grafted using a guided bone regeneration technique using a graft material and a membrane over the socket which was sutured closed primarily. It was allowed to heal for a period of several months and the patient was followed closely.
The patient was given chlorhexidine rinse and special postop instructions and cleocin antibiotics
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| Polyvinyl impression of maxilla and model and two simplant surgical guides |
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| Maxillary surgical model and Simplant surgical guides |
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| Maxillary surgical model and Simplant surgical guide |
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| surgical drill with surgical guide in place. Intraop verification#98 |
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| 3.5mmAstra implant to level of bone Periapical radiograph |
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| Implant #9 immediate post op radiograph |
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| 4mo post implant placement |
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| Final abutment restoration #9 |
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| Final restoration esthetic and cleansible |
3DCT Cone Beam Digital Work flow
Cone beam CT revealed significant buccal volume loss and patient was aware of this preoperatively and the issues aesthetically with the possibility requiring additional grafting. Patient understood these risks and wanted to proceed as is. Using a SimPlant Surgi guide a 3.5 x 13 mm Astra implant was placed in the #9 to the level of the bone as indicated on the radiographs. The implant was submerged and sutured closed at the time of placement and the patient was placed on antibiotic’s and tolerated the procedure well.
Four months postoperatively the patient was prepared for a final surgical abutment as a secondary surgical stage and placement of her final restoration which is aesthetic and cleansible. Despite the small amount of buccal bone volume it does not bother the patient and The soft tissue is healthy. Patient may later benefit from a connective tissue graft however is not interested at this time and has sufficient connective tissue supporting the prosthesis.
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| Final restoration esthetic and cleansible |
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| 30 year old in occlusion maxillary anteriors shows the a pleasing esthetic result and adequate anatomical appearance. |
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| Incisal view of maxillary anteriors shows loss of tender buccal plate and loss of horizontal width |
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Esthetic implant restoration of missing maxillary left central incisor 4 yr post-op
The Girldoc😉
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