Replacement of Fractured Central Incisor with Noris Tuff

clinical case
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Performed by Michael Katzap, DDS
Patient presented as walk in ER due to loose crown. Noted coronal fracture. Scan revealed apical third fracture too. Magnetic mallet to aid in atraumatic Exo. There was a 5mm buccal plate dehiscence pre-op. Apical portion stayed in the maxilla. I used the pilot drill to drill straight through the root till the root obturation material was eliminated.

Then started a new pilot osteotomy in a more Palatal direction. Once I noticed no more buccal dentin I switched to osseodensification mode to avoid buccal plate penetration or nasopalatine canal involvement. Grafted with augma, then immediately revealed the osteotomy by running the bur in reverses at 50 rpm without irrigation. Followed by implant placement. I scanned the implant position then placed a healing abutment, added more augma and covered with the shield. Patient came back three days later for the provisional crown.

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