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Fig. 1 Complicated crown-root fracture Fig. 2 Tooth 16 and 17 were restored Fig. 3 P e r i a p i c a l r a d i o g r a p h t a k e n
at tooth 15 restored temporarily with by implants which showed healthy peri- before removing the tooth fragment
composite resin. implant mucosa. showed moderate bone resorption and
apical radiolucency at 15.
Fig. 5 Shield was prepared and conser- Fig. 6 The implant is placed at palatal Fig. 7 Partial closure of the extraction
vative removal of the palatal root frag- position without contacting the shield. socket by a minor pouch flap and stitch.
ment.
Fig. 8 Uneventfully healing of the peri- Fig. 9 Shallow probing depth around Fig. 10 Titanium abutment was con-
implant soft tissue after 4 months. the implant. nected to the implant.
Fig. 11 A silicone index (pink) formed to Fig. 12 Excess luting material could be Fig. 13 A thin and evenly distributed
the internal configuration of the implant wiped off after placing the implant crown layer of luting agent was provided for
restoration. onto the silicone index. cementation.
The treatment plan implicated an immedi- 12mm, Straumann, Basel, Switzerland) was
ate implant placement within the meaning of placed according to the manufacturer's recom-
the socket shield technique and flapless im- mendations without contact to the shield. The
plant placement at tooth 15 without damaging apico-coronal position of the implant platform
the adjacent implants. was situated 1mm apical to the palatal mar-
Prophylactic procedures including tak- ginal gingiva. The gap between the shield and
ing 2g of antibiotic (Curam, Sandoz GmbH, implant surface was left to enable blood clot
Kundl, Austria) one hour before surgery and formation.(Fig. 6) The socket was partially
rinsing his mouth with 0.2% chlorhexidine closed by a minor partial-thickness pouch flap
solution were performed. Tooth 15 was dec- elevated at the buccal side and a Fig.ure-of
oronated with coarsed-grained diamond bur eight stitch. (Fig. 7) After 4 months, the soft
and the shield was segmented and prepared tissue around the implant healed uneventfully,
by osteotomy drills. Conservative extraction and represented shallow depth on probing.
of the palatal root fragment was done with (Fig. 8,9) The final impression was taken and a
periotome and forceps. (Fig. 5) The socket porcelain-fused-to-metal crown was fabricated.
was debrided gently and irrigated with normal A titanium abutment (RN synOcta cementable
saline. Implant bed preparation at the palatal abutment, Straumann, Basel, Switzerland) was
wall of the socket was performed and a root- torqued into the implant at 35N-cm. (Fig. 10)
form implant (Tapered Effect implant 4.1 X In order to reduce the cement extrusion into
Fig. 14 Final metal ceramic crown in Fig. 15 The buccal ridge contour of 15 Fig. 16 Periapical radiograph taken af-
situ. The gingiva height of 15 was main- was preserved. ter temporary cementation of the crown.
tained.