CATEGORY AUSTRALASIAN DENTIST101 CLINICAL Patient medical history Male • Non-smoker • 55 years old Fractured root extracted, degranulated and Megagen 4 x 10 mm placed into EthOss socket grafted site following the pushing technique protocol. This is not a recommended protocol but a technique that can be used to manage carefully selected cases. Patient Background: The patient is in good medical and dental health, he had undergone implant treatments with myself previously and was familiar with our immediate implant placement procedures. The significant travel distance for appointments and good working relationship, alongside his understanding of the increased risk of push-in protocol contributed to our decision to utilise the technique. Initial Treatment Plan: 1. Patient referred to the clinic for delayed placement and restoration of a dental implant. 2. Following placement protocol: Restoration planned for 12 weeks post-placement, following impression at 10 weeks. Summary: This patient was referred to the practice for implant placement of a recently extracted LR5 premolar. At the placement appointment 5 weeks after the extraction by the GDP it was noted that there was an apical root fracture. This complicated the initial plan as extraction requiring small amount of bone removal was required. Following the extraction of the apical root, the socket was significantly wider than the implant. This is evident in the radiograph, where the pin had fallen into the extraction socket. As a result, the socket was grafted and the implant was placed with zero bony contact, utilising the cover screw and prosthetic driver. Conclusion: While this protocol is not my primary recommendation for first-line treatment, it can be a viable option for carefully selected cases. This case also demonstrates the healing potential of EthOss BTCP/CS. Important Notes: Due to the low initial stability of a push-in protocol case, the cover screw and prosthetic driver were used to carry the implant to the placement site. X EthOss Graft and Implant Push In Placement Case by Dr Stuart Kilner, United Kingdom Fig 3: Papilla sparing flap exposing root. Fig 7: EthOssR Bone Graft material and implant placed with no primary stability. Fig 11: Sutured. Fig 15: Crown ready to place. Fig 4: Direction indicator radiograph Fig 8: Radiograp. Fig 12: Good keratinised tissue at review. Fig 16: Crown placed and excess blueRm. Fig 5: No drilling required. XLA socket and 4.8 direction indicator Fig 1: Fractured root underneath soft tissue. Fig 9: EthOss bone graft material added. Fig 13: Ready to load. Fig 17: Crown fitted. Fig 6: Implant Fig 2: Radiograph. Fig 10: More EthOss Bone Graft added but not overgrafted for easier primary closure. Fig 14: blueRm gel placed. Fig 18: Radiograph - Crown fitted.
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