By: Victor M. Sternberg, D.M.D. 

August 7, 2024

This young woman, at the age of 26, had two endodontically treated teeth that had developed  recurrent periapical areas. I do not have access to the original x-rays nor the original treatment  x-rays. The implants had been placed as immediates when the teeth #8 and #9 were extracted.  I received notes from the original dentist who placed the implants and restored them. Bone grafting was done because of facial dehiscences to begin with. These were probably  endodontically involved teeth that lost facial bone. Immediate implants are problems in those  areas until you first rebuild the bone and soft tissue. 

In any event, the woman has been through multiple procedures with the dentist trying to cover  up all of the exposed metal. It has been obviously unsuccessful. 

At this point she wants relief from her aesthetic concerns which weigh on her significantly. 

I have some thoughts on how to deal with this. I would appreciate your opinions going forward as to how you would manage this rather challenging issue. 

This case does point out some of the issues of immediate implants, particularly in the anterior  maxilla where there has been an endodontic issue resulting in loss of labial plate. The problem  is that correcting this issue is much more complicated than it would have been to stage  extractions and implants. 

Now the problem. How to deal with this. 

Thanks. 

Vic Sternberg 

By Westchester Center for Periodontal & Implant Excellence

December 30, 2023