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Minimizing alveolar bone loss

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Fig. 1: Gentle tapping with a mallet on the scalpel handle with #15c blade is used to separate the coronal PDL fibers.

Fig 2: The periotome is engaged into the created PDL space to luxate the root.

Fig. 3: Sectioning of a single root for an atraumatic extraction

Fig. 4: Vertical sectioning the mandibular first molar along the buccal groove that anatomically coincides with the furcation.

Fig. 5: The elevator is employed to create a wedge effect between the sectioned tooth structure to facilitate luxation between the separated tooth fragments.

Fig. 6: A circum-radicular piezo surgery is performed in a circumferential direction around an anterior tooth, with the exception of the facial side so as to preserve the facial alveolar bone plate and maintain esthetics.

Fig. 7: Benex extractor system

Fig. 8a: Reduction of teeth # 9 and 10. #8 and 11 will act as abutments for the provisional bridge

Fig. 8b: Bleeding epithelial edges that will promote creeping substitution on roots #9 and 10.

Fig. 8c: “Relieved” pontics #9 and 10 allow for creeping substitution and gingival coverage

Fig. 8d: Completed healing. Marginal correction of gingiva obtained under the pontics

Fig. 8e: Gingival growth over roots of #9 and 10

Fig. 9: (A) Root left in situ following immediate implant placement

Fig. 9: (B) Postop showing preservation of bone around the retained root which helps preserve the natural shape and volume of the buccal eminence.

Fig. 10 (A) Root preservation of #7 to preserve alveolar architecture

Fig 10: (B) Postop healing and esthetic outcome with a cantilever pontic #7 in the esthetic zone (Note: maintenance of facial eminence over #7)

Fig 10: (C) Postop radiograph showing retained root canal treated root.

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