Residual Roots as an Anatomical Guide for Implant Placement: Case Series With Two-Year Follow-up
As placement of implants into immediate sites involves management of the remaining root structure, these residual roots may be used as a guide for the development of osteotomy. This aids in implant positioning and prevents drill slippage into the residual root spaces during osteotomy drilling. Following completion of the osteotomy, the remaining root structure is extracted prior to implant placement into the site. The aim of this study is to assess the success rate of implants when the residual roots were used as anatomical guides for osteotomy. One hundred implants were placed in 57 patients, and 4 different types of implants were used: 47 Bioner TOP DM implants, 20 Nobel Biocare Replace implants, 25 Biohorizons Tapered Internal implants (Birmingham, Ala), and 8 Alpha-Bio Tec SPI Implants. The implants were placed into 57 patients. Osteotomies were placed through intact residual roots, which acted as anatomical guides for implant surgical placement. Patients had a follow-up period of 2 years, and in that time none reported discomfort after implant placement. There were no signs of peri-implantitis observed in any of the patients. Of all the implants placed, the Bioner TOP DM implant showed the least amount of crestal bone loss. Placing implants through residual roots as an anatomical guide is a useful technique that shows good results over a 2-year follow-up period.
Figure 1. Periapical radiograph of a nonrestorable carious lower first molar and missing second molar. Figure 2. Periapical radiograph of the pilot drill using the residual roots as a guide in placement, preventing the drill from deflecting into the mesial root space. Figure 3. Periapical radiograph of the final osteotomy drill into the immediate site following removal of the residual roots shell. Figure 4. Periapical radiograph of the implant placed into the immediate site following osteotomy using the residual roots to guide the drills and then root removal prior to implant placement. Figure 5. Periapical radiograph of the osteotomy drill to verify parallelism to the implant placed into the immediate site. Figure 6. Periapical radiograph demonstrating implant placement into the immediate site (L) and a healed site (R) prior to placement of osseous graft material over the fixtures. Figure 7. Radiograph following osseous graft placement over the implants and site closure. Figure 8. Periapical radiograph taken to verify fit of prosthetics demonstrating crestal bone levels in relation to the implant plateforms. Figure 9. Periapical radiograph 2 years postrestoration demonstrating bone-level maintenance and lack of bone loss crestally.
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