Vertical fracture in upper right second premolar associated with bony defect: best management?

I would not consider immediate implant placement. Attempt to retrieve apical fractured root remnant delicately, debride well, and irrigate copiously with peridex. Then, I would mix PRGF with 0.5cc encore and graft socket. You most likely have fenestration so you can suture nonresorbable cytoplast membrane without obtaining primary closure with nylon or vicryl. Alternatively, you can only use PRGF. I don't feel comfortable using solely when such defect present.

I concur! The only thing I add is disinfection with the Nd-yag laser to kill the deeper bacteria.

I would use SRP protocol , extract allow for 3 weeks soft tissue healing ,then flap and clean site very well , place Implant and graft .... load at 10 weeks . Will post video case Peter

CRS, I have a PerioLase NdYAG laser. What is your exact protocol for "disinfection with the Nd-yag laser to kill the deeper bacteria"

Immediate placement of an implant in this area is contraindicated in my opinion. The posted images show deficient bone, a dehiscence or fenestration of buccal and lingual walls, and a periapical lesion close to the sinus, which means there is no bone to engage apically other than the sinus floor. The safest way to proceed is to debride and disinfect the site, graft and delay implant placement until there is adequate regenerated bone. The advantage of Peter's procedure is that he can achieve primary closure over his graft, but there may not be enough bone to get primary stability of the implant. Using a cytoplast membrane can avoid a second entry to graft, but has to rely on excellent debridement and disinfection prior to graft placement. The suggestions given are sound, so reevaluate the case and plan the procedure according to the case details and your personal experience and preferences. Good luck!

Hi Carlos naturally there will be bone issue in this case and primary can be achieved with 1 or 2 threads but it is not necessary due again to material developments . We can routinely now place with no or very low stability graft around the Implant and have 72- 84 ISQ on Osstell in 8-10 weeks .We have a few hundred recorded cases (100% success) and numerous video cases showing both the placement with no stability and the flap raised at 10 weeks with Osstell readings being taken and then the case loaded after a few years . I have posted a video case on the "follow the Pink " site on facebook regards Peter

I don't see any rationale in hurrying up the things in this case.Immediate placement is best avoided. Debride the socket,graft it and wait to get adequate bone formation.Definitely agree with the use of laser in these kind of cases.Good luck

I have placed implants in B-L defects larger than this one and grafted with outstanding results. However, I agree with the other doctors. It is best to graft and give it time and revisit later to place the implant(s).