hello welcome back to another episode of chair set live i'm dr. justin chi clinical research
associate and a member of the team of practicing dentists here at gladwell laboratories today we
have a very interesting case presentation by dr. Charles Schlesinger in this case dr.
Schlesinger extracts tooth number 10 which has a very large periapical lesion and replaces it
with a Han tapered implant he also shows us how he grasps the site and prepares
the patient for an excellent resolution to a difficult problem let's take a look
hi I'm dr. Charles Schlesinger today I'd like to share with you an interesting case where we had
a patient with a maxillary lateral incisor that had failed and the donek treatment and a resultant
large periapical lesion I hope you enjoy this case presentation this patient presented to the office
with a chief complaint of a draining fistula above tooth number ten clinically the tooth
had had previous endodontic treatment a large post and an ill-fitting pfm restoration when we
palpated tooth number ten we also found that it had a plus-one mobility the radiograph confirmed
the suspicions of failing endodontics and with the very large post present the possibility of a root
fracture could not be ruled out all treatment options were discussed with the patient and she
ultimately decided on extraction and an implant placement after profound anesthesia was achieved
a spade proximity followed by a sharp beak forcep was used to remove the tooth it is very important
to preserve both the hard and soft tissue when trying to place an implant at the same time as
an extraction and the extracted tooth was then used to determine the length of the implant that
we were going to use in this case 13 millimeters long this length would allow us to engage apical
bone well beyond the apex of the root socket after extracting the tooth the socket and the lesion
were thoroughly divided with a sharp curette and it was at this time that a facial perforation was
discovered I then reflected the soft tissue back to expose the lesion used a slow speed handpiece
with a large carbide round bur in order to debride the site completely and then follow the Hahn
protocol to create the osteotomy while hugging the palatal wall of the socket a 3 by 13 millimeter
Han tapered implant was chosen and delivered to the osteotomy and the platform was placed
approximately one millimeter below the facial crest it was now time to graft the defects and the
area around the implant I used Newport biologics mineralized cortical cancellous blend the
allograft was then rehydrated with sterile saline and then delivered to the site here we can see the
graft placed in the facial defect and also within the gap around the implant and the crustal bone
since we were grafting such a large area I decided to use a resorbable collagen membrane in this case
it is a 15 by 20 millimeter membrane and we cut it down to size to fit the site and then placed it
to cover up the facial defect and then we draped it over the top of the grafted material the site
was closed using PTFE sutures in an interrupted fashion and a removable partial denture was placed
for temporization here is the final radiograph showing the 3 by 13 millimeter implant engaging
plenty of apical bone beyond the defect the patient's bone quality was not ideal and
therefore we did not attempt to load it right away and instead used a healing abutment the patient
returned in about seven days for suture removal here is the soft tissue already well on its way to
healing the ovate Pontic on the removable partial denture is going to help create the soft tissue
contours that we need in approximately two months the patient will be brought back the temporary
abutment will be removed an impression taken at that time for fabrication of a bio temp temporary
this bio temp will then be used to shape the soft tissue for the final restoration which will
then be delivered approximately one to one and a half months later I hope you enjoyed that short
presentation I look forward to seeing all of you at one of my upcoming Han dental implant courses
thank you thanks dr. Schlesinger for a great case presentation be sure to register for one of
his courses given at the Gladwell International Technology Center and at other locations around
the country coming early 2017 the full line of Newport biologics includes bone grafting
materials as well as membranes and is available from Gladwell direct on behalf of everyone here
at the lab thanks for watching chairside live and we'll see you right back here next time
you