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Volume21·Number4
Winter2006·TheJournalofCosmeticDentistry 93
compromised teeth. However, when
a critical tooth fails, the case can be
rescued using the described treat-
mentprotocol. The key points in the
author's opinion are as follows:
·Schedule removal of a hope-
less tooth as soon as possible
after it is identified. Avoid
time-sensitive destruction to the
periodontal structures that can
be caused by a root fracture, or
by periodontal or endodontic
infection.
·Plan on using the patient's exist-
ing crown or tooth as the pro-
visional. This will be the best
match for color and contour
while healing takes place.
·Minimize trauma during tooth
removal. Flapless removal of the
tooth as described is recom-
mended.
·Use a tapered implant. An im-
plant that best approximates the
natural anatomy of the tooth
will make the out come more
predictable.
·The round implant should
emerge in the facial portion
of the oval socket. The apex of
the implant should be directed
slightly lingual to the apex of
the natural tooth socket.
·Immediately place the implant
and provisional crown; this will
allow for preservation of papilla
and patient comfort. Keep out
of occlusion.
·Communicate with thel abora-
tory using photographs and
even the patient's original
crown to help match color,
contour,and surface texture.
"Service after the sale" can be a
yardstick to measure a dental prac-
tice.We all have failures; the authors
have learned much from theirs.
Accomplishing these cases takes
skill and patience. It is hoped that
sharing these cases with other
quality-and service-minded dentists
will allow them to turn failure into
success.
Acknowledgement
The authors extend special thanks to
the technicians at BCI Dental Labora-
tories, Petaluma, California, for their
contributions to the cases discussed in
this article.
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Figure 19: One week after surgery.
Figure 20: Three months after surgery.