Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA.
Center for Innovation and Precision Dentistry (CiPD), Schools of Dental Medicine and Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clin Adv Periodontics. 2024 Mar;14(1):9-14. doi: 10.1002/cap.10236. Epub 2023 Mar 23.
Edentulous sites with limited horizontal tooth-implant distance pose a challenge to clinicians. This case report describes root amputation of an adjacent compromised molar to maintain an optimal tooth-implant distance METHODS AND RESULTS: A 41-year-old female was referred for extraction and implant placement to replace her left, maxillary second premolar (#13), which had been diagnosed with a vertical root fracture. Extraction and ridge preservation of #13 was completed without complication. The 4-month postsurgical clinical examination revealed a narrow mesial-distal distance (5.69 mm) of the edentulous space (#13), which was influenced by the degree of divergence of the mesial buccal root of tooth #14. Cone-beam computed tomography (CBCT) analysis verified a periapical lesion on the mesial-buccal root of tooth #14. The amputation of the endodontically compromised mesial-buccal root of #14 was treatment planned to provide space and facilitate placement of a standard diameter implant without compromising the implant or adjacent teeth. Crestal bone levels were verified and maintained at the 1 year postoperative follow-up.
The findings of the case report demonstrate how root amputation of a compromised molar is an alternative solution for managing spatial limitations in contemporary implant dentistry. More studies are required to assess the reliability and long-term success of this approach.
Why is this case new information? There is insufficient evidence on the long-term efficacy of narrow-diameter implants. Clinical treatment guidelines are not sufficiently available. This paper presents an alternative approach to managing a specific scenario where mesial-distance distance is limited using root amputation of an adjacent compromised tooth. What are the keys to successful management of this case? Comprehensive diagnosis and stringent case selection Multidisciplinary treatment planning Evidence-based decision making What are the primary limitations to success in this case? Very specific clinical application; adjacent compromised tooth Long-term follow up is required.
牙列缺损且水平方向剩余牙-种植体距离有限的情况给临床医生带来了挑战。本病例报告描述了一种通过截除邻牙（受影响磨牙）近中根以维持理想牙-种植体距离的方法。
一位 41 岁女性因左侧上颌第二前磨牙（#13）诊断为垂直根折而就诊，要求拔除并植入种植体以替代该牙。#13 的拔除和牙槽嵴保存均顺利完成。术后 4 个月的临床检查发现缺牙区近远中距离较窄（5.69mm），这主要是由于#14 近中颊根的发散角度所致。锥形束 CT（CBCT）分析证实#14 近中颊根存在根尖周病变。计划对受影响的近中颊根进行根管截断术，以提供空间并便于植入标准直径种植体，同时不影响种植体或邻牙。术后 1 年的随访中，颊侧骨嵴顶高度得以维持。
病例报告的结果表明，对于当代种植修复学中空间限制的问题，截除受影响磨牙的近中颊根是一种可行的解决方案。需要更多的研究来评估这种方法的可靠性和长期成功率。
为什么这个病例是新信息？对于小直径种植体的长期疗效，证据不足。临床治疗指南尚不充分。本文提出了一种替代方法，用于处理因近中距离有限而导致的特定情况，即通过截除邻牙（受影响磨牙）的近中根来管理。成功管理这个病例的关键是什么？全面的诊断和严格的病例选择 多学科治疗计划 基于证据的决策 在这个病例中成功的主要限制是什么？非常具体的临床应用；邻牙受影响 需长期随访。
