Vertical Root Fracture. Preserving Alveolar Bone with the Help of Immediate Implantation

A 39-year-old female patient, nonsmoking, without chronic diseases was directed by a surgeon to endodontic treatment of the first left lower molar. Examination by means of a microscope on a labial surface of the crown showed a split, gingival pockets were absent.  

Vitality tests (hot and cold trial) showed negative results, and during vertical percussion pain was present. Radiography showed a radiolucent diffuse peridental area.  The restoration was extracted, so it was possible to see a fracture directed towards the crown cavity.

 After opening the crown cavity cleaning and rinsing with sodium hypochlorite was done, after that the fracture became clearly seen, it had buccal-labial direction.

Thus, it was understandable what tooth should be extracted and replaced with an implant.

By means of elevation atraumatic extraction of the tooth without flap carving was done. So, we managed to preserve the remaining lingual and buccal bone plates unhurt. After preparation and cleansing of the site an implant 10 mm in diameter and 4.3 mm long was placed. After placing an implant edge defect area was filled with transplanted deproteinized bovine bone. In the course of the operation mild swelling was present, but during a healing period the patient felt no discomfort. After a healing period which lasted nearly 4 months a temporal screw implant-supported restoration was placed. The implant started occlusive loading.