We find such cases in our clinic. We may confused at that time what we should do. Many options like surgical clinical crown lengthening, extraction followed by implant placement, extraction followed by fixed partial denture or removable partial denture. For long term prognosis, it is very difficult to select the treatment option.
There are lots of confounders to making a decision such as this. The first and probably the most important is the state periodontal state of the tooth in question and your client's oral hygiene status. Other consideration will include how much of the radicular structure is left in the alveolus and your client's motivation. Even in the face of all these, some options are more theoretical than practical; the pulp most time is contaminated warranting endodontic treatment of the radicular stump. So, what you really have is a root treated radicular structure serving to hold your alveolar bone from post extraction resorption. In light of aforementioned, a cost effective option will actually be to extract the root and place an implant (provided cost is not a hinderance) or provide a bridge or a removable partial.
Surgical clinical crown lengthening followed by Root Canal Treatment (RCT) then post and core and then deliver a crown. Is it good option? or RCT then Extrusion by orthodontic force then Post and core and then deliver a crown?
I think a lot will depend on the patient's compliance and his or her willingness to retain their natural dentition...as far as i am concerned i would definitely try 2 save the natural tooth instead of blindly going 4 implant....surgical crown lengthening, root canal treatment, post and core should be done but ultimately it all depends on the patient's will and whether they would be ready to come for so many appointments for saving a tooth..if the answer is no...definitely implant therapy..provided the periodontium is healthy and we have sufficient sound bone to receive an implant...
Some treatment are possible
1)Surgical extrusion with endo and splint
2)Ortho extrusion
3)implant
4)theet transposition if possible
5)Mariland Bridge without removal the root
6)Rochette bridge in very young patient
7)Classic(?)bridge
Depends from the experience of the Dentist anch from the request of the patient.
Best regards
Carmine C.L.Rapani
Thanks to Dr Carmine for your valuable treatment suggestion. All treatment, given by you , are good option for such case. But which have best prognosis option? However all option given by you have definitely some advantages and disadvantages. From that point of view, which should we go for ?
After using post-extraction implants immediate or delayed, for several years I have seen that the extrusion or extraction and replanting allows for better repositioning of the tooth so 'to frame him in the alveolus 3-4 millimeter from the crestal bone; if done within a few minutes, and with the presence of periodontal membrane intact brings good results.
I currently use this method and I'm happy with the results. Follow-up time after a 6 years time has not shown until now root resorption.
In the esthetic sector replanting or surgical extrusion should be certainly taken into account for the aesthetic results or to delay implant surgery.
A safe alternative may be implant placement : in these cases I prefer a delayed implant that allows me to manage the hard and soft tissues with better results than immediate post-extraction implants.
The perfect answer for your question may be 1) tray to perform an surgical extrusion 2) in case of failure first restore the soft and hard tissues and after put an implant.
Sorry for my english.
Best regards
Carmine Rapani
Thank Dr Carmine for your valuable suggestion to the question.
Best Regards
Abhay Das
My suggestion for predictable LONG TERM results:
Root extraction with immediate implant replacement, w/wo immediate temporization, and eventual crown restoration.
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