80% Bone Loss Post Root Canal: Replace with Implant and Crown?

If you really want to know why it resorbed, read the work of adreassen on traumatic avulsion and remplantation, it will be crystal clear. Yes replace it while you have a good papillae and good bone. If this is not the case (you didnt really specified very much) remove the tooth, place the implant and graft soft and hard tissue, use prp and or bmp, inmediate loading is best if possible. I would try all this flapless if possible(if ou need help, read some petrungaro or atend his courses) best of luck.

While it is probably a good idea to think about replacing this tooth, stability and lack of progression should give you pause. A couple of questions you might want to ask yourself is why is this tooth "flexibly" splinted. It should either be rigid or allowed to move independantly. In terms of technique, while I am sure that Dr. Berg's approach works well for him, this is an area that I would approach with caution. If you look at Petrungaro's flapless immediate implants, he doesn't really do a ton with infection and/or tremendous bone loss. If you are considering this, call him, he is always been gracious about answering questions. If this implant and regeneration fails, it will be UGLY. Of course, without clinical photos, we're just speculating. I might consider extracting the tooth, debriding the area of infection, overbuilding with an osseous graft and CTG and allowing the graft time to mature. The come back with fixture placement and another CTG. If you want, you can then immediately load the fixture. This will take much longer, but I think would be more predictable. Remember that technology doesn't replace biology.

I agree with JW's approach..... remove the tooth and graft; however I would not graft immediately. I would allow 6 weeks for the bone to cleanse itself, following a thorough debridement of the granulomatous tissue that was found in this area. These cells are extremely resistant and could invade and destroy a freshly placed graft.Give the body time to slough of any cells that were missed in the debridement, and chemical wash (i.e. citric acid or other materials) Dr. Berg's advise to use PRP and BMP are very important in getting the graft to take.....but once again I would differ in that after implant placement into a grafted site, I would wait 4-6 months for the implant to become osseointegrated; and would not consider immediate loading. Gerald Rudick dds Montreal

A difficult situation to be sure. Without radiographs or photographs we are all speculating. It is best to intervene now before any more bone or soft tissue is lost. Maintaining the papilla if possible will be critical to your patients success even if he/she has a low smile line. All patients lifttheir lip and look. You might want to look into distraction osteogenisis to attempt to "naturally" capture as much of the patients own bone as possible. Grafting the the anterior is always a difficult procedure so the less you have to augment the better. Even if you lose the tooth half way the distraction you will at least have less bone to graft. Get going sooner rather than later.

i am in accord with what said from collegueas and i proceed personally in this way: courettage of the location after the extraction of the tooth. then introducing in the alveoral bone of cristalline cephalosporine for five minutes. then putting contemporanelly osseous bone grafting with a one pice implant formed like the alveolar bone which ideated dr Gatti in Italy (see internet). I performed this way for two years with very good results.

Root canal treatment is done when there is no chance of tooth to be saved, and the patient doesn’t want it to be extracted although decayed. It is done to kill the vitality of the tooth and then filling it with mechanical components, and placing a cap over it. The procedure involves the removal of the nervous elements of the tooth which have been infected or decayed already due to microbial action or any physical pressures. Root canal Treatment